Bloomberg News has a detailed and gripping account by the wife of a cancer patient about the costs of end-of-life care. Among the key facts: "Some insurers drove harder bargains than others. In December 2006, for example, UnitedHealthcare, a unit of UnitedHealth Group Inc., paid $2,586 to the University of Pennsylvania hospital for a chest scan; in March 2007, after I switched employers, WellPoint Inc.'s Empire Blue Cross & Blue Shield paid $776 for the same $3,232 bill." More: "The entire medical bill for seven years, in fact, was steeply discounted. The $618,616 became $254,176 when the insurers paid their share and imposed their discounts. Of that, Terence and I were responsible for $9,468 -- less than 4 percent." The $254,000 could have paid to vaccinate "almost a quarter-million children in developing countries," says the article's author, Amanda Bennett. Sad story, excellent journalism. One policy point to take away seems to be that insurance companies do provide some value. On the other hand, looking at the difference between the $618,616 and the $254,176 as a savings is like the wife who comes home from a shopping trip and announces, "Honey, you'll be so happy, I saved the family $50,000! I bought a fur coat for $20,000 that was on sale, reduced from $70,000." It's hard to know the value being provided by the insurance companies without knowing how inflated the original bills are in reaction to the inevitable bargaining-down of them by the insurance companies.

If weight-loss diets work differently on those with different genes, might medicines, too?

The former secretary of the Treasury, Henry Paulson, is now giving journalists advice at the Harvard Club, Charles Gasparino reports.

That is Daniel Henninger's suggestion, in a column in the Wall Street Journal, citing Burton Folsom's book, The Myth of the Robber Barons: A New Look at the Rise of Big Business in America.

The collapse of the governor of New York, David Paterson, amid a controversy over his role in an alleged domestic violence case that involved one of his top aides -- compounded by a new scandal over his receipt of free World Series tickets -- may not seem to have much to do with Harold Ford Jr.'s decision not to run for Senate. But they are related in a way that gets less attention that it should. In a healthy political system, candidates have their flaws aired and discovered before they get elected. That's much harder to do if there's little or no real competition.

David Broder savages his Washington Post colleagues in this remarkable column on whether President Obama has screwed up by not following his chief of staff's advice. Writes Mr. Broder off the leaks from allies of Rahm Emanuel: "the chief of staff doesn't usually force the president out. When George H.W. Bush had had enough of John H. Sununu, of course it was Sununu who walked. Maybe the sources on these stories think Obama is the one who should leave."

John Hempton of Bronte Capital lives in Australia, which has universal health insurance coverage. Mr. Hempton writes, commenting on Warren Buffett's recent remarks on health care: "Anyone who tells you that you can have universal coverage without some queue rationing is lying. A decent part of the system however is working out what procedures must take place quickly and what procedures can safely wait a while. In Australia some people are in pain whilst on waiting lists. ...I doubt Buffett – as the world's second richest man – would find queue rationing acceptable for himself – but that discussion never came up. If you want to accuse him of hypocrisy go ahead. When my wife damaged her knee in a skiing accident we queue jumped using supplementary private health insurance. So accuse me of hypocrisy too. Buffett obviously knows that a system that radically cuts costs but has the government meet some of those costs will necessarily involve rationing. He is not a fool. He just never said how the rationing should take place – preferring to leave that discussion to experts. That way though he could sound reasonable and friendly whilst proposing reforms that will radically reduce some peoples' incomes and somewhat limit access to medical care. And that I guess is Warren Buffett to a tee. He sounds all genial – but underneath is one of the most hard-headed men you will ever come across." Exactly.

Despite White House claims that President Obama is "closing the revolving door between K Street and the executive branch," at least 45 former lobbyists serve in senior administration positions, and at least three Obama aides have now left the administration to become lobbyists, Timothy Carney reports in the Washington Examiner. The latest departure: a Treasury Department official, Damon Munchus, leaving to join a lobbying firm whose clients include Citigroup, the International Swaps and Derivatives Association, and the Managed Funds Association. Mr. Carney and the Washington Examiner are conservatives, but liberal Democrat Robert Reich says "big business's and Wall Street's generous flows of campaign donations to Dems, coupled with their implicit promise of high-paying jobs once Democratic officials retire from government" are "the rot at the center of the system. And unless or until it's remedied, it will be difficult for the President to achieve any 'change you can believe in.'"

First Paul Krugman started denouncing "the arrogance of elites." Then New York Times columnist Nicholas Kristof took aim at "liberal snobbishnes. Now Thomas Friedman is out with a column more or less endorsing the idea of cutting the corporate tax rate in America. Everyone's all excited about the Wall Street Journal's efforts to compete with the New York Times's New York news coverage; how about the New York Times's efforts to compete with the Wall Street Journal's editorial page? I tell you, they're turning into a bunch of right wingers over there.

Michael Lewis has a Vanity Fair profile of Michael Burry, the one-eyed, Asperger's Syndrome diagnosed founder of Scion Capital, who shorted sub-prime. At a certain point, Mr. Lewis writes, the banks that had sold Mr. Burry all the insurance betting that the sub-prime mortgages would go bad started to get nervous:

Three days later he heard from Goldman Sachs. His saleswoman, Veronica Grinstein, called him on her cell phone instead of from the office phone. (Wall Street firms now recorded all calls made from their trading desks.) "I'd like a special favor," she asked. She, too, wanted to buy some of his credit-default swaps. "Management is concerned," she said. They thought the traders had sold all this insurance without having any place they could go to buy it back. Could Mike Burry sell them $25 million of the stuff, at really generous prices, on the subprime-mortgage bonds of his choosing? Just to placate Goldman management, you understand.

The article goes on, later:

These five videos (I, II, III, IV, V) were posted last month, but a reader sent them in today along with the observation that, with the defection of Judge Richard Posner from the free-market camp, Richard Epstein's clarity and principle in expounding the ideas of classical liberalism is all the more brilliant, impressive, and important. Judge Posner comes in for some criticism in the second episode. Hoover Institution and National Review Online are responsible for the interview series.

"When someone else is paying, that is when medical care gets over-used," he writes. "Having someone else pay for medical care virtually guarantees that a lot more of it will be used. Nothing would lower costs more than having each patient pay those costs. And nothing is less likely to happen."

Actually, I think it is quite likely to happen. It's already happening, as more and more individuals and businesses can't handle the cost of first-dollar coverage and are switching to high-deductible plans or health savings accounts. And it may eventually happen for at least some of Medicare, too, because the alternative is letting health care costs devour the federal budget. For more, read Professor Battistella's book.

In keeping with my theory that you can sometimes learn more about political economy by reading the Vineyard Gazette, the paper published twice a week in the summer on Martha's Vineyard and once a week on the off-season, than by reading the New York Times or the Wall Street Journal, here's a recent article reporting that three entrepreneurs seeking to operate tour bus routes on the island are not having that easy a time in getting the necessary approvals from all six towns on the island. The prospect of privately operated buses "has already drawn concern from the Vineyard Transit Authority," the Gazette reports:

Vineyard Transit Authority administrator Angela E. Grant recently sent a letter to the Oak Bluffs selectmen challenging the sightseeing license application from Native Island Tours. She said the drop-off and pick-up nature of the tour was too similar to the transit services provided by the VTA.

Amity Shlaes has a column on Bloomberg News that, among other things, reminds readers that FDR was hostile to public-sector unionism:

In 1937, a year when industrial unions were striking furiously, FDR penned a letter to the head of the National Federation of Federal Employees, arguing that when the question regarded pay, hours and grievances, civil servants ought to be no different from those in the private sector. But collective bargaining, FDR wrote, was an exception. It couldn't, he said, "be transplanted into the public service." He particularly disapproved of "militant tactics" and reminded Luther Steward, president of the organization, that his own association's charter banned strikes.