The Mayo Clinic, praised by President Obama and mentioned earlier on the site in several earlier posts, has issued an open letter to Congress touting the Medicare Payment Improvement Act of 2009 introduced by Rep. Ron Kind, a Democrat of Wisconsin. The letter warns many providers are "already approaching a point where they can not afford to see Medicare patients. Expansion of a Medicare-type plan without a method to define, measure, and pay for healthy outcomes for patients will move many doctors and hospitals across this threshold, and ultimately hurt the patients who seek our care. We should not put more Americans into the current unsustainable system."

From The New Republic's health-care blog, a word from the former chairman of the Democratic National Committee, Howard Dean, a physician himself: "The reason there is no innovation in Europe is because of regulation on prices. ... Probably more Republicans agree with me on this issue than Democrats." Indeed. The blog notes that Dr. Dean is now being paid to work for the biotech industry.

Clifford Asness has posted a revised and extended version of his thoughts on health care. I had commented on his original draft earlier here. The new version includes the following:

I do not think health care should be tax-free if provided by an employer. Being provided by employers in the US leads to over-consumption (as it's pre-tax and the marginal cost of service is lower to the consumer), and worse, does indeed help lead to the fractious less efficient organization of insurance (and the famous, and real, "portability" problem). I certainly agree that this structure raises costs, but if you have a simple problem like this, you fix it, you do not say "hey, let's try communism."

One term that gets thrown about a lot in the health care debate is "rationing." Over at the blog of the Ayn Rand Center for Individual Rights, Don Watkins draws a distinction between health-care rationing imposed by the government and the allocation, or limiting, of health care by the working of prices negotiated or set in a free market. It's a distinction, as he puts it, between force and voluntary trade, or "between you choosing what groceries to buy and the government telling you what food you're allowed to eat." It's a useful distinction to keep in mind. For the individual who can't afford the caviar to put in the grocery cart, the outcome is pretty much the same as if the government had banned caviar, so the distinction may not mean all that much. But for those who can afford it, and for the caviar manufacturer, the outcome is different. And at least in the more free scenario, the person who can't afford the caviar one day has the opportunity to earn enough to afford it some day in the future.

The Republican governor of Louisiania, Bobby Jindal, a potential presidential candidate, seems to have picked up on the poll showing declining public trust in President Obama or on Clifford Asness's comments about "mendacious socialists." In today's Wall Street Journal, Mr. Jindal writes, "The left in Washington has concluded that honesty will not yield its desired policy result. So it resorts to a fundamentally dishonest approach to reform."

A Public Strategies Inc./Politico Poll finds that since March, "the number of Americans who say they trust the president has fallen from 66 percent to 54 percent. At the same time, the percentage of those who say they do not trust the president has jumped from 31 to 42." Over at CNN, columnist Gloria Borger writes about President Obama's "drooping recent poll numbers." He's also lost David Brooks. The president may head off to vacation on Martha's Vineyard without having passed a health-care overhaul, without having won congressional approval of his cap-and-trade climate-change and energy bill, without having gotten the labor unions their card-check bill, and without having gotten congressional action on immigration law changes. It's one thing for a president to be unpopular; it's another thing for an alternative to be more popular, which is why that Rasmussen Poll for 2012 showing Mr. Obama and Mitt Romney tied at 45% is getting some attention. Mr. Romney has plenty of critics on the right for the evolution of his views on abortion and for his health-care overhaul in Massachusetts, but concern about the future of the private sector economy is the sort of thing that might make a candidate with experience at Bain Capital attractive in comparison to one with experience as a community organizer. It'll be interesting to see whether the Paulson-Obama expansion of government involvement in the economy is a temporary deviation that is corrected by the 2010 or 2012 election or whether it is a more lasting shift more akin to the expansions of government in the FDR or Johnson-Nixon years. Right now it is too early to tell.

Paul Krugman defends "speculators" and the "Wall Street crowd" against Democrats in Congress. Really, he does. Okay, it's on his blog rather than in the actual print newspaper. But interesting nonetheless.

Here it is, from today's New York Times, warning that President Obama is losing popular support by lurching leftward, or failing to control Congress's lurch leftward, on health care, carbon, taxes, and stimulus.

In posts here and here FutureOfCapitalism.com mentioned that both the New Yorker magazine and President Obama were touting the Mayo Clinic as a model of how health-care delivery should work. Here is the Mayo Clinic's reaction to the health-care overhaul bill approved by Rep. Charles Rangel's Ways & Means Committee: "the proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite. In general, the proposals under discussion are not patient focused or results oriented. Lawmakers have failed to use a fundamental lever – a change in Medicare payment policy – to help drive necessary improvements in American health care. Unless legislators create payment systems that pay for good patient results at reasonable costs, the promise of transformation in American health care will wither. The real losers will be the citizens of the United States."

The Wall Street Journal has an article today that runs under the headline "Pay of Top Earners Erodes Social Security" and begins with the claim, "The nation's wealth gap is widening amid an uproar about lofty pay packages in the financial sector." There are so many unstated false assumptions in this article that it is difficult to enumerate them all, but, for starters, the article's most recent data is for 2007. Since then, there has been a major financial downturn that has led to a lot of financial-sector pay packages being either nonexistent or significantly less lofty. What that meant for the "wealth gap," a term the article seems to mean the same as an "income gap,' is unclear, but in past downturns, the income gap has often narrowed. The "uproar" the article refers to is largely manufactured; to the extent that there is an uproar over financial-sector pay at this point, it reflects mainly not outrage at pay levels but outrage at the federal bailout, the feeling being that those rescued by taxpayers should not be paid so highly.

The British retailer Tesco is getting into the banking business in a big way, the Financial Times reports. It's a reminder that the banking business can be dynamic. Just because the big existing banks fail or become wards of the government does not mean there is no money to be made in banking. The gaps can be filled either by startups or by firms that are strong in other fields that decide to expand into banking. One of the arguments for bailouts was that without them banking services or credit would become unavailable. That's like arguing that unless the government had stepped in to save Eastern Airlines there would be no passenger air service, or unless the government had stepped in to save the Duesenberg there would be no cars.

Discussion of a "Goldman Tax" on banks often includes mention of "moral hazard," the idea that banks will take more reckless risks if they know they can count on a bailout. A new paper from the National Bureau of Economic Research, provocatively headlined "Does Health Insurance Make You Fat?" demonstrates how moral hazard operates on an individual level. Economists find "stronger evidence" that having health insurance increases obesity. If you know that your insurance will pay for that bypass operation or diabetes medicine, why skip that second dessert? It'd be interesting to see research on how having health insurance (or life insurance) affects other behavior that poses health risks -- say, smoking, or riding a motorcycle without a helmet.

Consultants who advise families on college admissions are the subject of a front-page feature article in Sunday's New York Times, which informs us that the admissions advice industry is a "a rapidly growing, largely unregulated field," and that "No test or licensing is required to offer such services." The subtext seems to be that regulation and licensing are needed. The Times seems to favor regulation and licensing for every profession except for print journalists, an industry that miraculously seems somehow to function (albeit less and less profitably) without it.

The same week that Joseph Epstein was writing in the Wall Street Journal in celebration of the closure of a McDonald's, the historian David McCullough, speaking at the Vineyard Haven Library on Martha's Vineyard, was also casting aspersions on the fast food chain. Said Mr. McCullough, according to a report in the Vineyard Gazette: "I'm sometimes reminded to tell people something that I take heart from, year after year. So, anytime you start to get a little down about the state of American society or the state of American culture, keep in mind that today, still, there are more public libraries in the United States than there are McDonalds. May it ever be so."

In a footnote to his latest posting, which is mainly about health care, the founder of AQR Capital Management, Clifford Asness, writes, "my style is to write very aggressively and passionately about what I believe."

Give him credit for being self-aware, for willing to speak out with his own name attached, and for a lively, if sometimes over-the-top, style of writing and argumentation. Here's his description of advocates of an Obama-style overhaul of the health care system: "they are mendacious socialists who know that they will not achieve their massive imposition of state control on all aspects of life if they are honest about it. So they are dismantling liberty piece by piece."

My favorite line from this piece was Mr. Asness's reply to Rep. Charles Rangel's proposal to tax the rich more to pay for health care for everyone else. Why stop there, he asks, suggesting that the same rationale would justify "imprisoning the rich and harvesting their organs for better health care for everyone else." Mr. Asness may want to be careful lest someone in Washington pick up on this idea.