Must Reads for Doctor, Assistant, Hygienist and Admin team

I was at the Henry Schein Center in Seattle today working with the new DTS (Digital Technology Sales), Tyler Call.  He wanted to learn more about Dentrix so he could present a more effective demo to prospective Dentrix clients. 

My first question to Tyler was “Who is your target audience? Which team

members attend your Dentrix demo?”  I remember when I demoed Dentrix back in 2003 I was the only participant in the process and my doctor just wrote the check. 

It was important for me to know who attends the sales call because each team member is going to have a different set of priorities. Just like all of you who read this blog, you all have a different set of priorities.  So I thought for the holiday weekend I would put together a priority list for the doctor, hygienist, dental assistant and admin team.  Here are the top three posts in each category.

Doctor’s must reads . . .

1. Super Efficient with Templates - For all the Dentrix users, I want to give you some help when it comes to building templates, which can be a huge time-saver in your office. Here are some of my favorite template tips.
2. How to Read Your Clinical Notes - With more offices every day transitioning from paper charts to electronic charting, we need to find the most efficient ways to not only document in the clinical record and view the information without having to click all over the place.
3. Top Five Reports Every Doctor Should Read - I received an e-mail from a doctor the other day who had a situation that needed attention. Her clinical team had started posting procedures in the patient chart and had accidentally posted a root canal as “complete” rather than “existing.”

Dental Assistant must reads . . .

1. What is the Status of the Lab Case?  Do any of these lab-related scenarios ever happen in your office?
2. How to Chart a Supernumerary Tooth - Our patients walk in with some unusual situations, but one of the more common situations I see is an extra tooth or Supernumerary Tooth. 
3. Health History Update, being prepared for anything - If your patient had a medical emergency and your team had to call 911, how long would it take you to pull up his or her most current medical history? 

Dental Hygienists must reads . . .

1. Oops, the wrong tooth was removed from the chart - Have you had a patient in your chair for his or her 6-month checkup and, while you are perio charting, you notice that the wrong tooth is missing. 
2. Hygienists, you are one of the primary educators in the practice - We all know that research shows the systemic links between oral health and the rest of the body, especially the relationship between periodontal disease, cardiovascular disease, diabetes and respiratory disease.
3. Where do I Make Notes - Do you ever find yourself searching endlessly for the patient’s most recent list of medications? What if the doctor wants to know if the patient has any allergies before the anesthetic is administered?

Admin team must reads . . .

1. Can you write me an excuse note for school?
2. Get Creative with your ASAP List - I was working with an office recently and they have a program specifically for patients who do not pre-appoint. These patients are mostly retired and have very flexible schedules. 
3. Are you a Stickler for Accurate Numbers - How often does a patient call and ask, “What is my balance?” If it is a single patient ledger, the answer is relatively simple. But what if a mother of five calls and asks for each of her kid’s balances? 

Brexit or Fixit

Many commenters compare Brexit to the American revolution. I think the constitutional convention is a better analogy for the moment and challenge ahead. A first attempt at union resulted in an unworkable Federal structure. Europe needs a constitutional convention to fix its union.

The EU's first attempt was basically aristocratic/technocratic. Brussels tells the peasants what to do. The EU  needs a hardy dose of accountability, representation, checks and balances -- all the beautiful structures of the US Constitution. What little thought the EU put in to these matters is clearly wanting.

America did not wait for a state to leave. But, though even the Pope admits the EU structure wasn't working, the EU needed this wake up call. Bring the UK to the convention, and bring them back. Fixit. (#Fixit?)


Out of control economic regulation, labor laws, mandated social programs and "60% of British laws are made in Brussels" (I don't know the source of the widely quoted number, but the sentiment is as important as the fact)  are the most sensible arguments I heard for Brexit.

Fraser Nelson's WSJ essay expressed this well

The Brexit campaign started as a cry for liberty, perhaps articulated most clearly by Michael Gove, the British justice secretary... Mr. Gove offered practical examples of the problems of EU membership. As a minister, he said, he deals constantly with edicts and regulations framed at the European level—rules that he doesn’t want and can’t change. These were rules that no one in Britain asked for, rules promulgated by officials whose names Brits don’t know, people whom they never elected and cannot remove from office. Yet they become the law of the land. Much of what we think of as British democracy, Mr. Gove argued, is now no such thing.

The important point, I think, is not the outcome -- too much silly regulation, labor laws, and so on. The process is the important point.

America is, in my opinion, also a victim of stifling economic regulation, job-killing labor laws, incentive-destroying social programs. But, we still have a process in place -- in trouble, creaky, under attack by results-at-any-cost progressivisim.  But we have a process. Regulations are supposed to be authorized by Congress; should follow the Administrative Procedures act, with public comment, cost benefit analysis, and so forth; can be challenged administratively and then in court; and Congress itself can pass laws over-ruling regulators (which the President can veto, as he has).  Europe is missing this process; and european law is even worse than economic regulation here.

Last week's immigration ruling is an example of the same forces under strain in the US. I happen to agree with the Administration on policy grounds: People who have been here their whole lives, parents of US citizen children, should not face the constant risk of deportation, and should be allowed to work legally. (I had no idea there was such a thing as a "work permit" in the US, until President Obama mentioned it.) But, Congress passed silly laws mandating the opposite, and the Administration moved beyond its authority. When States are suing the Administration in the Supreme Court over its actions, we are in danger of Texit. But at least Texas can sue. Britain had no similar way to object to EU edicts.

Process matters, because democracy needs to form consensus and acceptance. When you force things down people's throats, they eventually gag.

Again quoting WSJ

Instead of grumbling about the things we can’t change, Mr. Gove said, it was time to follow “the Americans who declared their independence and never looked back” and “become an exemplar of what an inclusive, open and innovative democracy can achieve.” Many of the Brexiteers think that Britain voted this week to follow a template set in 1776 on the other side of the Atlantic. 

The answer for Europe is that it must allow people the option to change things they don't like. And 1787, not 1776 is the inspiration.

On economics, I think it's overblown.

Will this be a disaster for the British economy? Probably not. Norway, Switzerland, and Japan seem to get along.  If the UK decided to be a free economy free trade and open banking center, it could do wonders.

It is nice to see a consensus (though sometimes implicit) on the advantages of free trade. Leave did not argue for the importance of preserving British jobs with trade restrictions.  Alas, "free trade" now means "access to markets" or managed mercantilism.

The benefits of a continent-wide open labor market are easy to see in my business. As I visit universities around Europe, the typical smart young professor might come from Slovakia, have done an undergraduate degree in Spain, Masters' in the UK, PhD in Italy, is working in Sweden, with spouse working in London. The result is a resurgence of European universities, now dramatically better than they were two decades ago. The irony of Brexit is that English is the common language of Europe, making this integration possible.

So why are markets going so wild? I think political follow-on is very unstable. If Brexit leads to Britain becoming Norway it's not a big deal. If the UK breaks up, and the EU breaks up, we have big trouble ahead. Fixit instead.

Transport innovation

What is it?

I saw this in the parking lot of the hotel where I'm staying. Inspection: yes, it's the chassis of an early 1970s VW, with motor and transmission in place. The motor appears functional. It's connected to the gas cans. Yet, this is a trailer. Why? (Hint: it's parked next to a new Toyota CRV electric car.)

Answer: The owner has a nice new Toyota CRV electric. He extolled the virtues of the electric, its greenness, and the tax breaks and free charging options. But, it only has a 120 mile range, and sometimes he needs to drive longer distances on the freeway. This is Utah, after all.

So... the VW trailer. When in need, he puts the trailer in 4th gear, and turns on its electric system. The throttle is stuck full open. He pulls it to get going put, put put put... Then, the trailer pushes the car along. What if he needs to slow down? No problem, he hits the regenerative brakes on the Toyota, so now the VW is also charging up his batteries!

American ingenuity is still alive!

I did not ask if the highway patrol was aware of just how the trailer functions. Or the DOT, EPA, NHTSA, etc. etc.

Rajan on cash transfers and corruption

Raghu Rajan, who just announced he is stepping down as Governor of the Central Bank of India, gave a very interesting speech, that bears among other things on the question of social programs vs. cash transfers.

A big problem with government provided assistance in India is that the provision is corrupt:

Our [India's] provision of public goods is unfortunately biased against access by the poor. In a number of states, ration shops do not supply what is due, even if one has a ration card – and too many amongst the poor do not have a ration card or a BPL card; Teachers do not show up at schools to teach; The police do not register crimes, or encroachments, especially if committed by the rich and powerful; Public hospitals are not adequately staffed and ostensibly free medicines are not available at the dispensary; …I can go on, but you know the all-too-familiar picture.

Raghu has a thoughtful observation on what keeps this system going:

This is where the crooked but savvy politician fits in. While the poor do not have the money to “purchase” public services that are their right, they have a vote that the politician wants. The politician does a little bit to make life a little more tolerable for his poor constituents – a government job here, an FIR registered there, a land right honoured somewhere else. For this, he gets the gratitude of his voters, and more important, their vote.

...perhaps the system tolerates corruption because the street smart politician is better at making the wheels of the bureaucracy creak, however slowly, in favour of his constituents. And such a system is self-sustaining. An idealist who is unwilling to “work” the system can promise to reform it, but the voters know there is little one person can do. Moreover, who will provide the patronage while the idealist is fighting the system? So why not stay with the fixer you know even if it means the reformist loses his deposit?

So the circle is complete. The poor and the under-privileged need the politician to help them get jobs and public services. The crooked politician needs the businessman to provide the funds that allow him to supply patronage to the poor and fight elections. The corrupt businessman needs the crooked politician to get public resources and contracts cheaply. And the politician needs the votes of the poor and the underprivileged. Every constituency is tied to the other in a cycle of dependence, which ensures that the status quo prevails. 

The Mafia may have had a similar equilibrium

What to do? Cash transfers are an attractive option

... money liberates. Could we not give poor households cash instead of promising them public services? A poor household with cash can patronize whomsoever it wants, and not just the monopolistic government provider. Because the poor can pay for their medicines or their food, they will command respect from the private provider. Not only will a corrupt fair price shop owner not be able to divert the grain he gets since he has to sell at market price, but because he has to compete with the shop across the street, he cannot afford to be surly or lazy. The government can add to the effects of empowering the poor by instilling a genuine cost to being uncompetitive – by shutting down parts of the public delivery systems that do not generate enough custom.

Much of what we need to do is already possible. The government intends to announce a scheme for full financial inclusion on Independence Day. It includes identifying the poor, creating unique biometric identifiers for them, opening linked bank accounts, and making government transfers into those accounts. When fully rolled out, I believe it will give the poor the choice and respect as well as the services they had to beg for in the past. It can break a link between poor public service, patronage, and corruption that is growing more worrisome over time.

...if there is evidence that cash transfers are being misspent – and we should let data rather than pre-conceived notions drive policy -- some portion could be given in the form of electronic coupons that can be spent by the specified recipient only on food, education or healthcare.

 A good summary

 One of the greatest dangers to the growth of developing countries is the middle income trap, where crony capitalism creates oligarchies that slow down growth. [Just developing countries?!] ... To avoid this trap, and to strengthen the independent democracy our leaders won for us sixty seven years ago, we have to improve public services, especially those targeted at the poor. A key mechanism to improve these services is through financial inclusion, which is going to be an important part of the government and the RBI’s plans in the coming years.

Raghu's efforts to reform India's banking and financial system deserve more notice.

(PS: Blogging will be a little spotty for the next week and a half, as I'm off at a glider competition.)

Are you that doctor?

Are you the doctor who wants to give the patient a treatment plan estimate with a total case fee instead of a line item estimate? I have worked with many of you and I get it. You want to offer your patient a total case fee that includes everything for the end result.

I was working with a prosthodontist a few years back and he was one of those doctors who wanted a total case fee not a line item treatment plan. So we worked together and got creative with the software. This question came up again this week while I was talking with one of my colleagues so I thought I would share some ideas with you.

Here is what you can do. Create your custom procedure codes in the Office Manager. Go to the Office Manager > Maintenance > Practice Setup > Procedure Code Setup and add your new in-office custom codes. Here are some examples . . .

• Implant Option – Crown & Bridge
•  Implant Option – Fixed Hybrid
• Full upper rehabilitation
• Full lower rehabilitation
• Four on the floor (I don’t know what this is but I have heard it)

Make sure when you are creating these custom in-office procedure codes that you mark them to not bill to insurance because you will have to bill things out by line item in order for your chart to look accurate, but this is a way you can provide a total fee estimate that the patient will understand.

Now when you treatment plan one of these codes, you can note everything that is included in the note field (see the screen shot here). Then, when you print out the estimate for the patient, it will only show a full fee and then what is included in that fee. Let me know what you think. I would love to hear some feedback.

Syverson on the productivity slowdown

Chad Syverson has an interesting new paper on the sources of the productivity slowdown.

Background to wake you up: Long-term US growth is slowing down. This is a (the!) big important issue in economics (one previous post).  And productivity -- how much each person can produce per hour -- is the only source of long-term growth. We are not vastly better off than our grandparents because we negotiated better wages for hacking at coal with pickaxes.

Why is productivity slowing down? Perhaps we've run out of ideas (Gordon). Perhaps a savings glut and the  zero bound drive secular stagnation lack of demand (Summers). Perhaps the out of control regulatory leviathan is killing growth with a thousand cuts (Cochrane).

Or maybe productivity  isn't declining at all, we're just measuring new products badly (Varian; Silicon Valley). Google maps is free! If so, we are living with undiagnosed but healthy deflation, and real GDP growth is actually doing well.

Chad:

First, the productivity slowdown has occurred in dozens of countries, and its size is unrelated to measures of the countries’ consumption or production intensities of information and communication technologies ... Second, estimates... of the surplus created by internet-linked digital technologies fall far short of the $2.7 trillion or more of “missing output” resulting from the productivity growth slowdown...Third, if measurement problems were to account for even a modest share of this missing output, the properly measured output and productivity growth rates of industries that produce and service ICTs [internet] would have to have been multiples of their measured growth in the data. Fourth, while measured gross domestic income has been on average higher than measured gross domestic product since 2004—perhaps indicating workers are being paid to make products that are given away for free or at highly discounted prices—this trend actually began before the productivity slowdown and moreover reflects unusually high capital income rather than labor income (i.e., profits are unusually high). In combination, these complementary facets of evidence suggest that the reasonable prima facie case for the mismeasurement hypothesis faces real hurdles when confronted with the data.

An interesting read throughout. 

[Except for that last sentence, a near parody of academic caution!]  

Financial Choice

If you're interested in policy rather than politics, the package of legislative proposals coming out of Congress are a lot more interesting than the Presidential race at the moment. Speaker Paul Ryan is rolling out "A Better Way" package and Rep. Jeb Hensarling has just announced a "financial CHOICE act" to fundamentally reform Dodd-Frank. (Most quotes are from Jeb Hensarling's speech at the Economic Club of New York. See also  NYT coverage.)

These efforts will, I think, become much more important later on. The presidential race will decide whether this agenda can survive the instant veto that it faces now.  (This is a non-partisan comment. Hilary Clinton could likely assure a landslide by announcing she will work with Paul Ryan to craft and pass it.)

In any case, it defines a clear program that may be the focus of economic policy under a presidency of either party. And I think that's healthy as well.  We are still living in the shadows of Franklin Roosevelt's 100 days, and an increasingly imperial presidency. But the current need is not for a flurry of new legislation and executive orders to address a crisis. We need a steady clean-up of the legal and regulatory mess of the last few decades. For that project, it may be better for policy leadership to come from Congress, and by careful and patient drafting of actual legislation.

The legislation is still being drafted, which is why it would be lovely if more of the media and blogosphere were paying attention rather than to the latest antics of the presidential candidates. The congressional staff writing these things are paying attention and the proposals can be refined!

Today, a look at the Financial CHOICE act.

More capital, and the carrot of less regulation

...there is a growing consensus surrounding the idea of a tradeoff between heightened capital levels and a substantially lower regulatory burden....[We] will relieve financial institutions from regulations that create more burden than benefit in exchange for meeting higher, yet simple, capital requirements...Think of it as a market-based, equity financed Dodd-Frank off- ramp... the option remains with the bank.

How to measure capital? This is a hard nut.

...banks that maintain a simple leverage ratio of at least 10 percent and, at the time of the election, have a composite CAMELS rating of 1 or 2 may elect to be functionally exempt from the post-Dodd-Frank supervisory regime, the Basel III capital and liquidity standards, and a number of other regulatory burdens that pre-date Dodd-Frank. 

This is an element worthy of more discussion. Leverage ratios have problems too, as they do not distinguish the riskiness of assets.  CAMELS ratings have their own problems.

As blog readers know, I think we can keep going well beyond 10% capital. I'd like to see steady incentives for more and more capital, rather than an arbitrary threshold.  My current thinking leads to reducing subsidies for debt, a fee on short term debt, and using ratios of market value of equity to debt. Or a schedule of regulatory reductions: so much for 10% capital, more for 20% capital, do what you want at 100%. But we're in danger here of repeating a Libertarian party sort of fight whether there should be drivers' licenses in Nirvana, so let's leave this as an open question for refinement.

It seems natural to ask for more capital on riskier assets, but a beautiful paragraph on risk-weights explains why that doesn't work.

Risk-weighting is simply not as effective. First, it is far too complex, requiring millions of calculations to measure capital adequacy. Second, it confers a competitive advantage on those large financial institutions that have the resources to navigate its mind-numbing complexity. Third, regulators have managed to get the risk weights tragically wrong, for example, treating toxic mortgage-backed securities and Greek sovereign debt as essentially risk-free. One myopic globally imposed view of risk is itself risky. Finally, risk-weighting places regulators in the position of micro-managing financial institutions, which politicizes credit allocation. Witness the World Bank recently advertising its zero risk rating under the Basel Accords for their “green bonds.”

The regulatory carrot: A bank with enough capital

would be deemed “well capitalized” for prompt corrective action purposes; It would no longer be subject to Basel Committee capital or liquidity requirements as implemented by the U.S. banking regulators;  It would be able to make capital distributions freely; and would additionally be able to consummate transactions without being subject to the regulatory challenge of increasing risk to the stability of our banking or financial system, or on grounds related to capital or liquidity standards of concentrations of deposits or assets. 

... no Federal rule establishing “heightened prudential standards” of the type provided for in Dodd-Frank would apply to qualifying banking organizations, including the living will requirement...In short, a strongly capitalized qualifying bank will be enabled to remove government bureaucrats from its boardroom and lend and invest freely.

From the executive summary,

Exempt banking organizations that have made a qualifying capital election from any federal law, rule, or regulation that permits a banking agency to consider risk “to the stability of the United States banking or financial system,” added to various federal banking laws by Section 604 of the Dodd-Frank Act, when reviewing an application to consummate a transaction or commence an activity.

A linguistic note: Not once in this speech, except while quoting others, does Rep. Hensarling use the phrase "to hold" capital. Every instance is "raise" capital. And explicitly, 

equity capital can be put to work no differently than debt or deposits. It is not money put under a mattress.

And as to the ballyhooed impossibility of raising capital, 

U.S. banks have raised hundreds of billions in new capital

Who says nobody in Congress understands finance!

Bankruptcy; no more "designation"  

The centerpiece of Dodd-Frank is the FSOC (Financial Stability Oversight Council's) ability to "designate" a firm as "systemically important," and then to "resolve" it, in place of bankruptcy.  This will go.

...bankruptcy, not bailouts. Recently the House passed the bipartisan Financial Institution Bankruptcy Act, which creates a new subchapter of the Bankruptcy Code tailored to specifically address the failure of a large, complex financial institution.....

The speech goes on with several good reasons bankruptcy is better than resolution.  I hear cheering from John Taylor's office already.

 Retroactively repeal the authority of the Financial Stability Oversight Council (FSOC) to designate firms as systematically important financial institutions (SIFIs) 

Fed Lending

...we impose on the Fed Bagehot’s famous dictum: lend freely, but only to solvent institutions, only against sound collateral, and only at interest rates high enough to dissuade those who are not genuinely in need. 

I'm a little leery of this one. Dictums are not analysis. If you want to stop a run, you have to lend pretty freely. Private institutions like a clearinghouse to do that once existed, but they have been put out of business by the Fed.  Nobody knows who is solvent vs. illiquid; the point of a run is that collateral that was "sound" yesterday is not today.  And if you want to stop a run, who cares if it's insolvent or illiquid? The Fed doesn't need quickly salable collateral, being super senior in bankruptcy is enough.  Bagehot's dictum is a great way to run a hedge fund. It's not necessarily the right way to run a central bank.

I worry that we are headed for the worst of all worlds -- people expect bailouts and free fed lending, but the government is legally constrained from doing so. All the moral hazard and none of the crisis mop. If we're going to go in this direction, it has to be crystal clear to people running banks that the government will not be able to step in next time, even stretching laws, and they'd better set things up carefully ahead of time. I'm afraid people are not going to believe any legal restrictions.

Rule of Law

Some of the most interesting parts of this proposal really belong together in "restoring the rule of law to regulation." That's a big project that I hear simmering in much of this Congressional planning. And, based on the daily news (for example the latest on the FCC takeover of the internet) not a minute too soon.

CFPB 

The "Consumer Financial Protection Bureau" is out of control.

fundamentally reforming the CFPB......task it with the dual mission of consumer protection and competitive markets, with a cost-benefit analysis of rules performed by an Office of Economic Analysis. 

 Replace the current single director with a bipartisan, five-member commission which is subject to congressional oversight and appropriations. 

... Repeal authority to ban bank products or services it deems “abusive” and its authority to prohibit arbitration. ... Repeal indirect auto lending guidance.

Federal Reserve 

One of the most thought-provoking proposals splits the Federal Reserve's regulatory power from its monetary policy power. It puts bank regulation, like all regulation, in the rule-of-law framework that is supposed to exist for regulation: cost-benefit analysis, Administrative Procedures Act, Congressional oversight, and so forth. Various quotes: 

Require that the different sets of conditions under which stress tests are evaluated subject to notice and comment period. 

... makes sure every financial regulation passes a rigorous cost-benefit test... 

We will put all the financial regulatory agencies on budget. The bare minimum level of accountability to “We the People” is to have their elected representatives in Congress control the power of the purse, as inscribed in our Constitution. 

But, wisely,

protects the Federal Reserve’s independence in conducting monetary policy by leaving that function off-budget. The Fed’s prudential regulatory and financial supervision activities, however, will now be subject to the normal and transparent congressional appropriations process.

SEC

...due process rights. Too many citizens have been “shook down” or abused by their government. Thus we will provide an immediate right of removal to federal court for respondents in administrative proceedings.  We will ensure that disciplinary proceedings are public, that all fines imposed by regulatory agencies are sent to the Treasury for deficit reduction, that regulatory entities created by Congress are subject to full congressional oversight, and that other due process rights are strengthened.

There is a curious section on increasing the SEC's power:

the Financial CHOICE Act will impose the toughest penalties in history for financial fraud, self- dealing and deception.

We will double the cap for the most serious securities law violations and will allow for triple monetary fines when penalties are tied to illegal profits. We will give the SEC new authority to impose sanctions more closely linked to investor losses – and increase punishments even more for repeat offenders. We will increase the maximum criminal fines for both individuals and firms that engage in insider trading.

I'm not aware of a big problem in the SEC (and DOJ) not being able to ruin people's lives adequately, or extort large enough settlements from banks. Perhaps this is an olive branch, which won't hurt much.

Broader project

A sense of the broader project to restore rule of law in regulation.

Dodd-Frank gives FSOC the ability to designate companies as Too Big to Fail if it “determines that material financial distress” at the company “could pose a threat to the financial stability of the United States.” But nowhere in Dodd-Frank, or anywhere else in the U.S. Code for that matter, are these terms defined. So by defining these vague terms in any fashion that pleases them, this “super-group” of regulators can exert ultimate functional control over almost any large financial firm in our economy, and do so with utter disregard for due process. This is not the rule of law; it is the rule of rulers, and it’s an anathema to a free and democratic society.... 

Next, we repeal the Chevron doctrine requiring the judiciary to give deference to financial regulatory agencies’ interpretation of the law. The doctrine is unfair and an affront to due process and justice. 

I've gone on long enough. Legislation needs a public comment mechanism too, as this is  a big package, which though on a very good track can surely be refined a bit.

Checking insurance benefits will suck the life out of you unless you change your system

Dental insurance benefits are the thorn in our side every day. Checking benefits, eligibility and maximums for our patients is a great benefit … and it also sucks the life out of us to the point where we don’t have time for other things during

the day. There needs to be a balance between it being a customer service task and a hand-holding task. The insurance benefits belong to the patient. They do not belong to the practice and we need to put the verbal skills in place to help our patients understand this.

One thing I have been doing with my practices is teaching them to transfer that ownership back to the patient in a way that is beneficial to the patient and not too time-consuming for the practice. The easiest, most efficient way I have found is using the eCentral Insurance Eligibility feature inside of your Dentrix software. Have you seen the “E” all over inside of your Dentrix software and wondered what it does? CLICK HERE to learn how eCentral Insurance Manager works.  Let me share with you some of my tips in using this amazing tool.

What has worked really well for many offices is to print a copy of the electronic benefits for the patient and then send a copy to the patient’s Document Center for your reference. Now, how you hand off the information to the patient makes a big impact on how much you will be babysitting in the future. So here are some of my best tips . . .

• When you print out the eligibility benefits from eCentral for the patient, I would highlight a few key pieces of information (insurance company phone number, maximum and coverage percentages).
• Hand the patient the printed copy of his or her benefits and say something like, “I took the liberty of checking on your dental benefits for you and here is what we received from your plan. Notice I have highlighted some of the important things about your plan. One thing I want to point out is that if there is a procedure you need that is not on this print out, then we don’t know how much your insurance company will pay so we estimate zero.”
• Let patients know if they would like more details about their plan, you highlighted the insurance company’s phone number for them.

Using eCentral Insurance Eligibility not only as a tool for your practice efficiency but also using it as a resource for your patient will help you to strengthen your relationships with your patients and they will trust you more. Trust will help build your practice and grow your referrals.

Lottery Winners Don't Get Healthier

Alex Tabarrok at Marginal Revolution had a great post last week, Lottery Winners Don't get Healthier (also enjoy the url.)

Wealthier people are healthier and live longer. Why? One popular explanation is summarized in the documentary Unnatural Causes: Is Inequality Making us Sick?

The lives of a CEO, a lab supervisor, a janitor, and an unemployed mother illustrate how class shapes opportunities for good health. Those on the top have the most access to power, resources and opportunity – and thus the best health. Those on the bottom are faced with more stressors – unpaid bills, jobs that don’t pay enough, unsafe living conditions, exposure to environmental hazards, lack of control over work and schedule, worries over children – and the fewest resources available to help them cope. 

The net effect is a health-wealth gradient, in which every descending rung of the socioeconomic ladder corresponds to worse health.

If this were true, then increasing the wealth of a poor person would increase their health. That does not appear to be the case. In important new research David Cesarini, Erik Lindqvist, Robert Ostling and Bjorn Wallace look at the health of lottery winners in Sweden (75% of winnings within the range of approximately $20,000 to $800,000) and, importantly, on their children. Most effects on adults are reliably close to zero and in no case can wealth explain a large share of the wealth-health gradient:

In adults, we find no evidence that wealth impacts mortality or health care utilization.... Our estimates allow us to rule out effects on 10-year mortality one sixth as large as the crosssectional wealth-mortality gradient.

The authors also look at the health effects on the children of lottery winners. There is more uncertainty in the health estimates on children but most estimates cluster around zero and developmental effects on things like IQ can be rejected (“In all eight subsamples, we can rule out wealth effects on GPA smaller than 0.01 standard deviations”).

(My emphasis above)

Alex does not emphasize the most important point, I think, of this study.  The natural inference is, The same things that make you wealthy make you healthy. The correlation between health and wealth across the population reflect two outcomes of the same underlying causes.

We can speculate what those causes are.  (I haven't read the paper, maybe the authors do.) A natural hypothesis is a whole set of circumstances and lifestyle choices have both health and wealth effects. These causes can be either "right" or "left" as far as the evidence before us: "Right:" Thrift, hard work, self discipline and clean living lead to health and wealth. "Left:" good parents, good neighborhood, the right social connections lead to health and wealth.

Either way, simply transferring money will not transfer the things that produce money, and produce health.

Perhaps the documentary was right after all: "class shapes opportunities for good health."  But "class" is about more than a bank account.

Also, Alex can be misread as a bit too critical: "If this were true." It is true that health and wealth are correlated. It is not true that more wealth causes better health.  The problem is  not just "resources available to help them cope."

Why a blog post? This story is a gorgeous example of the one central thing you learn when doing empirical economics: Correlation is not causation. Always look for the reverse possibility, or that the two things correlated are both outcomes of something else, and changing A will not affect B.   We seldom get an example that is so beautifully clear.

Update:  Melissa Kearney writes,

"Bill Evans and Craig Garthwaite have an important study [AER] showing that expansions of EITC benefits led to improvements in self-reported health status among affected mothers. 

Their paper provides a nice counterpoint to the Swedish lottery study, one that is arguably more relevant to the policy question of whether more income would causally improve the health of low-income individuals in the U.S.

Thanks Melissa for pointing it out. This is interesting, but I'd rather not get in to a dissection of studies here -- just who takes advantage of EITC benefits, how instruments and differences do and don't answer these problems. The main point of my post is not to answer once and for all the question -- how much does showers of money improve people's heath -- but to point out with this forceful example for non-economists the possibility that widely reported correlations - rich people are healthier -- don't automatically mean that money showers raise health.  

How to raise GDP 10%, and reduce inequality too

Chang-Tai Hsieh and Enrico Moretti have a very nice new working paper "Why do Cities Matter?"

..increased wage dispersion lowered aggregate U.S. GDP by 13.5%  Most of the loss was likely caused by increased constraints to housing supply in high productivity cities like New York, San Francisco and San Jose. Lowering regulatory constraints in these cities to the level of the median city would expand their work force and increase U.S. GDP by 9.5%. 

Roughly, the same worker, working the same job, in San Jose or San Francisco, earns double what he or she earns somewhere else in the country.  Here is their plot of wages across cities:

Sure: Chang-Tai Hsieh and Enrico Moretti

The right tail there isn't just missing -- it was absent in 1964. There weren't any cities (MSA's) with 50% higher wages than average in 1964. That's New York, San Francisco and San Jose now.

What does this have to do with growth?

Suppose there are good opportunities, for high productivity employment in an area like Silicon Valley. Businesses start, try to expand, and bid up wages to match the higher productivity. That's all good, but with strong housing restrictions it stops there. New people can't move in to take those high wage jobs. They try to, but they bid up house prices until the higher house price matches the higher wage.

Now suppose there are fewer restrictions on building new houses or more dense houses. Then lots of new workers can move in, the businesses an expand. Eventually, a much larger group of workers gets the higher wages, and the business expands a lot.

So, productivity-enhancing ideas mixed with housing restrictions don't do nearly as much for growth as those ideas with more open housing markets -- especially markets open to newcomers. Housing restrictions also hurt measured inequality, by creating this large wage gap. (Inequality measures typically do not control for local housing costs. Rent controls and "affordable housing" lotteries may seem to help low income people, but only those who have been there for a while, not workers moving in for new and better jobs.)

The paper has a clear model and careful calculation of this effect.  Their bottom line is that US GDP would be overall about 10% higher than it is now -- and not just in some free-market nirvana, just if New York, San Francisco and San Jose were "only" as restrictive as the typical US city.

This fits in to the long simmering issue of how much micro-economic distortions and rent-seeking are hindering long run growth. My view, here for example, holds that micro economic regulation is holding back growth a lot. The contrary view is that regulation is a small-potato annoyance, 1-2%  growth is as good as it gets, go back to slicing up the smaller pie. The trouble is that for all the regulation horror stories, it's hard to put together solid numbers.

Here is one. 10%. Just from zoning laws and other building restrictions.

Universal Basic Income

Universal Basic Income is in the news. Charles Murray wrote a thoughtful piece in the Wall Street Journal Saturday Review. The Swiss overwhelmingly rejected a referendum -- but on a proposal quite different from Murray's.

Murray proposes that "every American citizen age 21 and older would get" $10,000 per year "deposited electronically into a bank account in monthly installments." along with essentially a $3,000 per year health insurance voucher.

The most important part of Murray's proposal: UBI completely replaces

 Social Security, Medicare, Medicaid, food stamps, Supplemental Security Income, housing subsidies, welfare for single women and every other kind of welfare and social-services program, as well as agricultural subsidies and corporate welfare. 

There is a lot to commend this idea. First, it would reduce the dramatic waste in the current system:

Under my UBI plan, the entire bureaucratic apparatus of government social workers would disappear

Moreover, the bulk of government spending now does not go to people who are really poor. SSI and medicare go to old people, many of whom are quite well off. Housing subsidies such as the mortgage interest deduction go to people with big mortgages and big tax rates -- nor poor people. Murray doesn't really emphasize this point, but his proposal is far more progressive than the current transfer system.

Second, it would reduce the very high disincentives of the current system, which traps people.

 Under the current system, taking a job makes you ineligible for many welfare benefits or makes them subject to extremely high marginal tax rates. Under my version of the UBI, taking a job is pure profit with no downside until you reach $30,000—at which point you’re bringing home way too much ($40,000 net) to be deterred from work by the imposition of a surtax.

If I read Murray correctly, he takes away $3,500 of the benefit between $30,000 and $60,000, which is an 11.6% surtax. That applies on top of the Federal 25% marginal rate, 16% payroll tax, state income and payroll taxes and so forth. So not zero, but it is a lot less disincentive than many current programs.

Both considerations place the proposal not in the "perfect world" category, but "how can we do what we're trying to do now a lot more effectively." So, evaluate it as such.

The biggest problem in the argument is the biggest selling point: We trade a check -- even much more than $10,000 -- for complete elimination of everything else.

A UBI will do the good things I claim only if it replaces all other transfer payments and the bureaucracies that oversee them. If the guaranteed income is an add-on to the existing system, it will be as destructive as its critics fear.

There are a lot of these "big trades" on the table, and there should be more. A big carbon tax, in return for complete elimination of all the regulatory nudges and crony energy related subsidies. A VAT in return for complete elimination of income, corporate, estate, and other taxes.  Lots of infrastructure money in return for elimination of Davis-Bacon, endless legal challenges EPA reviews, and other regulations, strict cost-benefit analysis rather than subsidized anachronisms, and so on.

In all these much simpler cases, the deal doesn't get off the ground. Will the "right" allow a big enough carbon tax? Will the "left" really get rid of their subsidies? Will the "right" really allow a large enough VAT? Will the "left" really not just pile all the other taxes back on top? Making these deals is hard enough even when both sides admit the deal would be good.

That case is going to be even harder here. The "left" has not even thought about the deal, let alone agreed in principle with only trust issues remaining! The Swiss referendum [sad aside on media: it was really hard to find the actual text!] made no mention at all of a swap -- it was pure basic income on top of other social programs.

Programs will remain tempting, because a flat basic income is not close to the "perfect world" social insurance system, or even common sense. We want to give more help to people who need more help. That lets us be more generous to those who do need help, and contains moral hazard that people who don't really need help should be working and paying taxes to supply help. Social security goes to old people, because old people objectively are less able to work.  Disability goes to disabled people, because it's harder for them to work as well. Unemployment insurance goes to people who just lost jobs, we know they are more likely to have suffered a bad shock. Insurance payments go to people whose houses have burned down.

These social insurance programs are indeed ineffective, bureaucratically bloated, and do a terrible job of picking who really needs help from who doesn't. But UBI takes a pretty extreme view that the project is completely hopeless, and the Government should do no conditioning at all, other than reported income:

Government agencies are the worst of all mechanisms for dealing with human needs. They are necessarily bound by rules applied uniformly to people who have the same problems on paper but who will respond differently to different forms of help.

Well, ok, but the call of the better world will be hard to resist, and the "left" has far from accepted that bureaucracies are "the worst" mechanism for sorting the needy from the less needy.

There will still be unfortunate people,  they will still need help, and our electorate will still demand programs to help them. Disability: Ok, it's grown  out of control, but some people really are disabled. You're only going to give them $10,000 and turn your back? What about the guy who takes his check, blows it all on a weekend of meth and beer, and now is lying in the gutter, his children homeless?

Some people will still behave irresponsibly and be in need before that deposit arrives, but the UBI will radically change the social framework within which they seek help: Everybody will know that everybody else has an income stream. It will be possible to say to the irresponsible what can’t be said now: “We won’t let you starve before you get your next deposit, but it’s time for you to get your act together. Don’t try to tell us you’re helpless, because we know you aren’t.”

He goes on to extol the virtues of private charities. I don't think our electorate is ready to completely forswear all bureaucratic help. And the vine grows back.

Eliminating housing subsidies? Agricultural subsidies? "Corporate welfare?" These are all great ideas on their own. If we could do that, our economy would be in a lot better shape than it is.

A bit of paternalism is pretty ingrained in social policies, and it isn't necessarily a bad thing. I'm happier paying taxes to support food, clothes and school for the kids, and basic housing than I am to subsidize a beer and meth weekend. Murray already gives in, by restricting the first $3,000 to a health insurance voucher. If he's going to get rid of social security, he should restrict the next $1,000 to a forced savings plan. If we're going to get rid of all housing programs (a great idea) the next $2,000 is a rent/mortgage voucher.

Some paternalism is justified as a pre-commitment. We know if they blow the money, we'll enact social programs to help them after the fact.

There is a deeper problem -- and I have a constructive solution.

In fact, Americans use far fewer benefits than they are eligible for. Many programs have 2% take up rates. Lots of people eligible for medicare, Obamacare subsidies, disability food stamps, welfare, home heating subsidies, and so on and so on all the way down to Palo Alto's income-based parking permit system don't take advantage of the benefits. If each American took advantage of every subsidy and social program to which he or she is entitled, the country would be bankrupt in about 10 minutes.

Why not? Well filling out the forms is a pain. And, more importantly, most people really do use social programs for a limited time. Call it a stubborn independence ethic or some remaining shame to taking assistance, it's there. For now. I fear that welfare states fall apart when the social stigma of taking the money fades.  

For now, both act to limit moral hazard. If it takes a few hours and trips down to an unpleasant bureaucracy to get help, then only people who really need it are likely to ask. If there is some remaining social stigma to getting help, then only people who really need it are likely to ask -- and likely to get out as fast as possible.

Before I get howls of comments on how heartless this view is, remember the objective -- money is limited, we want to use it to help people who really need it, and if we can do something to keep out people who don't, we can be a lot more generous to those who do. If we impose some cost on people to get help, we get them to reveal who really needs it, and we can help them a lot more.

So, my major suggestion -- please, don't automatically send the check to every American the minute they turn 21! Don't send it to my kids! At least, make people go down to a dull and dirty office, stand in line, fill out a long form, and repeat once a year.

Murray limits the benefit once you get to $30,000 per year, introducing a surtax above that level. I've been mulling over a different way to limit benefits and thereby make them more generous: Limit by time, not by income. You can have an additional (say) $10,000 per year, for 5 years, at any point in your life. Most people using social programs do in fact use them to get out of trouble and back on track. Let's make that the expectation. This is not permanent income support, this is help to get out of trouble.  That lets us be more generous, without blowing the budget, and without inducing as large a marginal tax rate to working.

Murray has a lot of speculation on how society will adapt to $10,000 per year check and NO other social programs.

the entire bureaucratic apparatus of government social workers would disappear, but Americans would still possess their historic sympathy and social concern. And the wealth in private hands would be greater than ever before. It is no pipe dream to imagine the restoration, on an unprecedented scale, of a great American tradition of voluntary efforts to meet human needs. 

Trust private charity, with an ever-larger share of income in plutocratic hands? I don't see Bernie Sanders supporters signing on to the deal on that basis.

The known presence of an income stream would transform a wide range of social and personal interactions. The unemployed guy living with his girlfriend will be told that he has to start paying part of the rent or move out, changing the dynamics of their relationship for the better. The guy who does have a low-income job can think about marriage differently if his new family’s income will be at least $35,000 a year instead of just his own earned $15,000.

Or consider the unemployed young man who fathers a child.

Maybe. Maybe not. We do have some experience with corners of societies that live off government checks. We have more experience with places where lots of people don't work. Welfare neighborhoods in the 70s to mid-90s. Europeans living on the dole. Molenbeek. Saudi Arabia. By and large, places where most people live on government checks or large numbers don't work are not happy places.

One can also speculate in contrary ways. Labor markets are more and more regulated and restricted. Well, if people can all get $10,000 from the government, why fight for lower minimum wages for entry level workers, looser occupational restrictions, and so forth?

Murray also confuses the issue, and substantially weakens the case, I think, by wandering off into a soliloquy on once robots do everything there won't be any more jobs.

We are approaching a labor market in which entire trades and professions will be mere shadows of what they once were... the jobs (now numbering 4 million) that taxi drivers and truck drivers will lose when driverless vehicles take over... Advances in 3-D printing and “contour craft” technology will put at risk the jobs of many of the 14 million people now employed in production and construction...The list goes on, and it also includes millions of white-collar jobs formerly thought to be safe..

... as many as 47% of American jobs are at risk...it will need to be possible, within a few decades, for a life well lived in the U.S. not to involve a job as traditionally defined.  

I think this is wrong. Murray acknowledges

I’m familiar with the retort: People have been worried about technology destroying jobs since the Luddites, and they have always been wrong.

Indeed they have. The invention of the tractor was way worse than the invention of the self-driving car for the jobs of about 70% of Americans and about 99% of everybody else at the turn of the 20th century -- farm labor. Murray writes

 It takes a better imagination than mine to come up with new blue-collar occupations that will replace more than a fraction of the jobs..

It's a good thing that every time in the past we did not rely on policy writers' imaginations to come up with occupations for people. I think the answer is pretty clear: services. When robots make everything for us, then people make money supplying services to each other.

But I don't have to be right either.  The deeper problem with this line of argument, common on the left, is how utterly hopeless it is, and how it contradicts Murray's case.

Hopeless: Really? Your vision for the future is that 47% of working-age Americans will be living on a $10,000 per year check from the government, doing nothing? $10,000 is not a lot of money, barely sustaining a life on the margins in pockets of poor rural america. It buys a used trailer and a six pack of beer in a place with little hope.

We can do better than that! And we can. We're talking about a several decade shift in the labor force here. If services are the answer, we need to fix schools and other barriers that keep people from getting the skills needed to earn money in the service economy. We need to fix labor markets to make it easier to hire people in flexible ways and help them to develop skills on the job.

Contradictory: Murray's numbers work out (I think, I haven't checked, but it seems plausible) in today's America. But if half our labor force, and all our retired or non-working people, are living off a government check, the cost would explode past what the country could possibly support with any level of taxation.

So set this apart, recognize that adapting to automation will require getting people skills not sending them checks. And that is going to mean keeping the price system alive. It has to be crystal clear that computer programming pays more than goof off majors.

Bottom line, most of the Murray's social changes and adaptation to robot workforce is, I think, a mistake and a distraction.

A Big Deal -- along with the others -- remains attractive: Substantial cash grants and vouchers in place of many current programs -- could offer substantially more help to people who need it, with far fewer distortions.  In place of middle class subsidies -- housing, college, etc. -- and corporate subsidies even better.  But let's not pretend it will cure social ills, or save us from confronting labor market distortions.

How to generate an Unscheduled Treatment Report for patients who have already said "Yes" to treatment.

Back in February, I wrote an article on using visual tools to help communicate the status of the treatment plan with your entire team. If you want to re-read it, CLICK HERE. If you have implemented some of these visual aids, did you know that you can filter one of the Treatment Plan reports to give you a narrower search?

Open the Treatment Planner or the Treatment Plan Panel in the chart and click on Print. For most of you, this is how you would print a treatment plan estimate for the patient … but have you ever printed the Practice Treatment Case Report? Even though I am all about going paperless, this report gives you some great search tools to find patients who have unscheduled treatment and have been marked with a particular status.

Going back to my February article, if you have marked the case with a particular status, then you can search for it. For example, let’s say you have marked a case as Accepted or High Priority, then it is now searchable. Click on the Print > Practice Case Status Report and select your filters. See the image below to follow along.

• Fig 1 shows how you can choose a Case Status. You can select all the cases you have marked as accepted and get a call list from this selection. If you have been reading my blog for a while, you know how much I love the Treatment Manager. However, it does not have this filter (which I think is a great tool).
• Fig 2 shows how you can select a Case Severity. If you are marking your cases as Immediate, Eventual or Optional, then you can filter your report by one of these choices.

Using these visual tools can help you and your team communicate better and give your admin team the options necessary to generate a really good call list when they are following up with patients and trying to fill openings in the schedule.

These are just a couple of examples of how you can use the status and severity tools. You can discuss with your team how they would best serve your practice.

WSJ growth oped -- full version

WSJ Oped. Now that 30 days have passed, I can post the whole thing. Previous post.

Ending America’s Slow-Growth Tailspin

Sclerotic growth is America’s overriding economic problem. From 1950 to 2000, the U.S. economy grew at an average rate of 3.5% annually. Since 2000, it has grown at half that rate—1.76%. Even in the years since the bottom of the great recession in 2009, which should have been a time of fast catch-up growth, the economy has only grown at 2%. Last week’s 0.5% GDP report is merely the latest Groundhog Day repetition of dashed hopes.

The differences in these small percentages might seem minor, but over time they have big consequences. By 2008, the average American was more than three times better off than in 1952. Real GDP per person rose from $16,000 to $49,000. And those numbers understate the advances in the quality of goods, health and environment that came with growth. But if U.S. growth between 1950 and 2000 had been the 2% of recent years, instead of 3.5%, income per person in 2000 would have risen to just $23,000, not $50,000. That’s a huge difference.

Looking ahead, solving almost all of America’s problems hinges on re-establishing robust economic growth. Over the next 50 years, if income could be doubled relative to 2% growth, the U.S. would be able to pay for Social Security, Medicare, defense, environmental concerns and the debt. Halve that income gain, and none of those spending challenges can be addressed. Doubling income per capita would help the less well off far more than any imaginable transfer scheme.


Why is growth slowing down? One camp says that we’ve run out of ideas. We were supposed to have flying cars and all we got was Twitter. Get used to it, the thinking goes, and start fighting over the shrinking pie.

Another camp holds that the culprit is “secular stagnation,” a “savings glut” demanding sharply negative interest rates that the Federal Reserve cannot deliver. That outlook attracts clever new economic theories and promotes vast new stimulus spending of the sort that Japan has fruitlessly followed.

The third camp (mine) holds that the U.S. economy is simply overrun by an out-of-control and increasingly politicized regulatory state. If it takes years to get the permits to start projects and mountains of paper to hire people, if every step risks a new criminal investigation, people don’t invest, hire or innovate. The U.S. needs simple, common-sense, Adam Smith policies.

America is middle-aged and overweight. The first camp says, well, that’s nature, stop complaining. The second camp looks for the latest miracle diet—try the 10-day detox cleanse! The third camp says get back to the tried, true and sometimes painful: eat right and exercise.

The first two camps are doubtful. How much more growth is really possible from better policies? To get an idea, see the nearby chart plotting 2014 income per capita for 189 countries against the World Bank’s “Distance to Frontier” ease-of-doing-business measure for the same year. The measure combines individual indicators, including starting a business, dealing with construction permits, protecting minority investors, paying taxes and trading across borders. Unlike the more popular ease-of-doing business rankings, this is a measure of how good or bad things are with 100 being the best observed so far, or “Frontier,” score.

In general, the higher a country’s score, the higher its per capita income. The Central African Republic scores a dismal 33, and has an annual per capita income of just $328. Compare that to India (50.3, $1,455), China (61, $7,000) and the U.S. (82, $53,000).

The U.S. scores well, but there is plenty of room for improvement. A score of 100 unites the best already-observed performance in each category. So a score of 100—labeled Frontier—is certainly possible. And, following the fitted line in the chart, Frontier generates $163,000 of income per capita, 209% better than the U.S., or 6% additional annual growth for 20 years. If America could improve on the best seen in other countries by 10%, a 110 score would generate $400,000 income per capita, a 650% improvement, or 15% additional growth for 20 years.

If you think these numbers are absurd, consider China. Between 2000 and 2014, China averaged 15% growth and a 700% improvement in income per capita. This growth did not follow from some grand stimulus or central plan; Mao tried that in the 1960s, producing famine, not steel. China just turned an awful business climate into a moderately bad one.

It is amazing that governments can do so much damage. Yet the evidence of the graph is strong. The nearly controlled experimental comparison of North Korea versus South Korea, or East Germany versus West Germany, is stronger. But if bad institutions can do such enormous harm, it follows inescapably that better institutions can do enormous good.

A growth agenda doesn’t fit neatly into current policy debates. This is fortunate, as new ideas are easier to swallow than defeats.

Parties argue over tax rates, but what’s really needed is deep tax reform, cleaning out the insane complexity and cronyism.

Parties argue over how much to raise or cut spending for social programs, but what’s needed is a thorough overhaul of the programs’ pernicious incentives. For example, Social Security disability needs to remove its disincentives to work, move or change careers.

Parties argue about education spending, but America needs the better schools that come from increased choice and competition.

Most of all, the country needs a dramatic legal and regulatory simplification, restoring the rule of law. Middle-aged America is living in a hoarder’s house of a legal system. State and local impediments such as occupational licensing and zoning are also part of the problem.

Growth-oriented policies will be resisted. Growth comes from productivity, which comes from new technologies and new companies. These displace the profits of old companies, and the healthy pay and settled lives of their managers and workers. Economic regulation is largely designed to protect profits, jobs and wages tied to old ways of doing things. Everyone likes growth, but only in someone else’s backyard.

There is hope. Washington lawmakers need to bring about a grand bargain, moving the debate from “they’re getting their special deal, I want mine,” to “I’m losing my special deal, so they’d better lose theirs too.” While the current presidential front-runners are not championing economic growth, House Speaker Paul Ryan (R., Wis.) and other House members are. And if economic-policy leadership moves from a chaotic presidency to a well-run Congress, that may be healthy for America’s political system as well as for the economy.

Update: response to some criticis