nocebo effect or temper tantrum?

[_Tarski]

I'm sure you know about the placebo effect and I think I am not alone in thinking that this effect or something like it is behind the healings that religious people claim for themselves.
While on a Mormon mission in Japan, I apparently healed a woman of a serious and painful bladder infection. She informed me that the pain was gone the instant I laid hands on her (all the while I was fighting inner doubts).

But there is a negative version of this called the "nocebo effect"

In a NYT article, Paul Enck and Winfred Hauser opine "EVERYONE knows that a placebo — a fake medication or sham procedure, typically used as a control in a medical trial — can nonetheless have a positive effect, relieving real symptoms like pain, bloating or a depressed mood. The placebo effect is a result of the patient’s expectation that the treatment will help.

But expectations can also do harm. "

Enter the nocebo effect-the mirror image of the placebo effect.

This nocebo effect seems closely aligned with the notion of self fulfilling prophecy which seems to act on groups as well as on individuals.

People seem to act to prove they were right about something even if it harms them.
At times it seems like role playing and occasionally just plain old acting.

When my son was about 9 years old we tried to get him to wear a helmet while riding his bike around a rather busy neighborhood in Santa Monica.
He fought back hard--didn't think it was cool.
He claimed, implausibly, that it made him more likely to crash. It obtructed his vision, hurt his head, and made him dizzy etc.

So sure enough, when he put it on at our insistance, he began to ride around in a purposely crazy way and acted out an obviously controlled crash and cried in a clearly fake manner as if to say "see, now look what you have done to me". Actually, he ended up hurting himself a bit in the process of putting on this little show.

When BCSpace anounced he was firing employees since Obama won, I mentally recounted the tantrum of this nine year old.

Of course, this kind of thing is apparently going on all over, as assholes preemtively fire employees and downsize businesses all before anything has actually changed and based on FOX news level economic ideas. (Seems folks have bought into their own BS. FOX news is a machine for anti-cheerleading the economy when they think it will make the democrats look bad. Limbaugh famously hoped Obama would fail right from the start).

I wonder if it is the case that being typically religious, these folks have above average abilities in the nocebo/self-fullfilling prophecy department.

One wonders if whole economies can crash or horrific biblical prophecies come true in the middle east just because otherwise unfounded beliefs make people act in ways that confirm the belief?

I think so.

I just wonder when it is conscious (as with my 9 year old son and our own BCSpace) and when it is happening unconsciously more like the nocebo effect.

As far as the economy, one remaining and interesting question is, will rational people (including so called liberals) take advantage of the wingnut histrionic self-destruction and make a profit? Who will be the business winner that hires the people that BCSpace and others just fired in their temper tantrum?
Here is your chance for a business advantage all you lefties!

PS; It seems odd when you think about it. The 10% required for full participation in the Mormon church seems far more of a small business burden than any Obamacare reality. Oh sure you don't have to participate in the church but one can also give up being a part of American society as well I suppose.
I guess 10% of gross to the Mormons is OK for business, but heaven forbid that Papa John's might have to raise the price of a pizza by 18 cents so everyone can have healthcare.

[_Shiloh]

Tarkski,

Interesting thoughts.

I can't speak for BC or Papa Johns or anyone else -- in order to so would require me to understand their cost structures, margins, etc...

I wonder though, if there is an element here driven completely by self-interest.

Let's say I have a business with 200 employees. Of those, 150 work 35-37 hours/week. All are salaried. I have negotiated an affordable, but very basic group health plan. It doesn't cover Viagra or birth control, but members see the Dr. when necessary and ensure they have a yearly check-up regardless of how they feel. If they had a heart attack, they would be mostly covered -- minus the deductible (which, even at 5%, is going to get pretty expensive if employees become seriously ill).

With Obamacare I have a choice. I can do one of three things:

1. "Upgrade" the group health policy to meet the minimum requirements mandated by Obamacare. The added cost means that I'll have to either move some folks to PT or let some workers go. The alternative is that I raise prices. The problem is the widgets I produce are a commodity and if I raise my prices my sales will drop significantly. So goes life as a commodity maker or dealer -- always the price taker and never the price maker.

2. Drop my current plan entirely and pay the $2,000 / employee / year that works 30+ hours / week that does not have the type of coverage approved -- as mandated by Obamacare. This may be cheaper than option 1.

3. Move all (or most) of my FT employees to 29.5 hrs so the Obamacare mandates don't apply. I am able to hire many new employees at 29.5 hours due to the broad reduction of hours. One thing that worries me is that my competitors may decide to drop group health policies altogether. If that happens they will be able to reduce prices and still maintain the thin margins necessary to stay in business. If my competitors lower their prices I have no choice but to lower prices as well -- I make a commodity like staples or nails. Otherwise I go out of business, lose my small fortune, and all my employees will be out of work. So, there is a very real possibility that I may have to drop insurance. We'll see.

Most rational people will choose option 3. Why? Because it is the moral choice? Nope. Because it furthers the self-interest of the business owner? Yep. Choice 3 also happens to suck for employees no matter how you slice it.

Now, we can condemn these widget makers (collectively) for being so heartless as to pursue their self-interest at the expense of their employees. I don't care if it is right or wrong, it is going to happen. That's reality. I wish I lived in a world of fairy dust and sugar plumbs but unfortunately I live in a world where a business competitor will do whatever is legally necessary to gain an advantage over me and to put my business' sustainability in doubt. We just have to look to the work of John Nash to see how this is going to play out.

We may also say that these business owners should gladly pay the additional health costs or just suck it up and pay $2,000 / year. This very well may be true but I would ask: how many Americans knowingly didn't take a deduction last year or decided to pay a little extra in federal income tax .. you know, just because they felt it their responsibility to help pay his fair share? I would be surprised to find one.

I think that in some cases, this may just be self-interest doing what it always does.

Also, I've heard people go on and on about how Obamacare will add $.14 to the cost of making a pizza at Papa Johns. This seems so low!! Well, what if Papa Johns average margin / pizza is only $.20?

** I am not a lawyer nor an expert on Obamacare. I have discussed it as I understand it from reading the WSJ and NY Times. If I have misstated something here regarding the law's mandates, please please please correct me.

[_Tarski]

Tarkski,

Interesting thoughts.

I can't speak for BC or Papa Johns or anyone else -- in order to so would require me to understand their cost structures, margins, etc...

I wonder though, if there is an element here driven completely by self-interest.

Let's say I have a business with 200 employees. Of those, 150 work 35-37 hours/week. All are salaried. I have negotiated an affordable, but very basic group health plan. It doesn't cover Viagra or birth control, but members see the Dr. when necessary and ensure they have a yearly check-up regardless of how they feel. If they had a heart attack, they would be mostly covered -- minus the deductible (which, even at 5%, is going to get pretty expensive if employees become seriously ill).

With Obamacare I have a choice. I can do one of three things:

1. "Upgrade" the group health policy to meet the minimum requirements mandated by Obamacare. The added cost means that I'll have to either move some folks to PT or let some workers go. The alternative is that I raise prices. The problem is the widgets I produce are a commodity and if I raise my prices my sales will drop significantly. So goes life as a commodity maker or dealer -- always the price taker and never the price maker.

2. Drop my current plan entirely and pay the $2,000 / employee / year that works 30+ hours / week that does not have the type of coverage approved -- as mandated by Obamacare. This may be cheaper than option 1.

3. Move all (or most) of my FT employees to 29.5 hrs so the Obamacare mandates don't apply. I am able to hire many new employees at 29.5 hours due to the broad reduction of hours. One thing that worries me is that my competitors may decide to drop group health policies altogether. If that happens they will be able to reduce prices and still maintain the thin margins necessary to stay in business. If my competitors lower their prices I have no choice but to lower prices as well -- I make a commodity like staples or nails. Otherwise I go out of business, lose my small fortune, and all my employees will be out of work. So, there is a very real possibility that I may have to drop insurance. We'll see.

Most rational people will choose option 3. Why? Because it is the moral choice? Nope. Because it furthers the self-interest of the business owner? Yep. Choice 3 also happens to suck for employees no matter how you slice it.

Now, we can condemn these widget makers (collectively) for being so heartless as to pursue their self-interest at the expense of their employees. I don't care if it is right or wrong, it is going to happen. That's reality. I wish I lived in a world of fairy dust and sugar plumbs but unfortunately I live in a world where a business competitor will do whatever is legally necessary to gain an advantage over me and to put my business' sustainability in doubt. We just have to look to the work of John Nash to see how this is going to play out.

We may also say that these business owners should gladly pay the additional health costs or just suck it up and pay $2,000 / year. This very well may be true but I would ask: how many Americans knowingly didn't take a deduction last year or decided to pay a little extra in federal income tax .. you know, just because they felt it their responsibility to help pay his fair share? I would be surprised to find one.

I think that in some cases, this may just be self-interest doing what it always does.

Also, I've heard people go on and on about how Obamacare will add $.14 to the cost of making a pizza at Papa Johns. This seems so low!! Well, what if Papa Johns average margin / pizza is only $.20?

** I am not a lawyer nor an expert on Obamacare. I have discussed it as I understand it from reading the WSJ and NY Times. If I have misstated something here regarding the law's mandates, please please please correct me.

We will see how it shakes out and what inevitable pains result from such a big change.
But the pre-emptive firings and downsizing I see happening look more like tantrums than any serious attempt to work within the new rules. I think creative and ethical people will find a way to succeed without being jackasses. But we will see.

Maybe the Republican shouldn't have pushed out the public option/single payer ideas.
Afterall, there do exist extremely competative ans successful businesses in all those countries with universal healthcare. Many successful and big businesses/corporations are located in countries we would accuse of being "socialist". Maybe they will out compete us -ironic.

Oh and I would certainly be willing to pay a few more cents or even a dollar more for pizza--especially if it didn't taste like warmed over social despair.

[_sock puppet]

Tarkski,

Interesting thoughts.

I can't speak for BC or Papa Johns or anyone else -- in order to so would require me to understand their cost structures, margins, etc...

I wonder though, if there is an element here driven completely by self-interest.

Let's say I have a business with 200 employees. Of those, 150 work 35-37 hours/week. All are salaried. I have negotiated an affordable, but very basic group health plan. It doesn't cover Viagra or birth control, but members see the Dr. when necessary and ensure they have a yearly check-up regardless of how they feel. If they had a heart attack, they would be mostly covered -- minus the deductible (which, even at 5%, is going to get pretty expensive if employees become seriously ill).

With Obamacare I have a choice. I can do one of three things:

1. "Upgrade" the group health policy to meet the minimum requirements mandated by Obamacare.
* * *

2. Drop my current plan entirely and pay the $2,000 / employee / year that works 30+ hours / week that does not have the type of coverage approved -- as mandated by Obamacare. This may be cheaper than option 1.

3. Move all (or most) of my FT employees to 29.5 hrs so the Obamacare mandates don't apply. I am able to hire many new employees at 29.5 hours due to the broad reduction of hours. * * *

Most rational people will choose option 3. Why? Because it is the moral choice? Nope. Because it furthers the self-interest of the business owner? Yep. Choice 3 also happens to suck for employees no matter how you slice it.

Choice 3 would not be rational. The part about moving FT employees to 29.5 hours, anyway. Adverse employment action (like reducing hours) taken by a private company to prevent employees from being entitled to employee benefits opens the company up to legal liability to the affected employees under a federal law that has been in place since 1974--unless the company already made and implemented Choice 2 before taking the Choice 3 step.

You are wise, Shiloh, to see the limitations of legal advice found in the pages of the WSJ and NY Times.

Choice 2 is the obvious one for a business--$2,000/year/EE working 30 or more hours a week is less expensive than providing medical insurance. Then if you take the Choice 3 step, you've reduced it even more--but likely the inefficiencies that go with more part-time workforce than fewer full-time employees will make Choice 3 not cost effective except for in the most menial, basic type of jobs--where part time workers are already the rule.

Choice 2 is what Obama wanted all along. Choice 1 was allowed as a way to make it look like single payer wasn't being mandated, even if it means it will take a few years longer to achieve it.

[_Chap]

Meanwhile, to much of the rest of the world it seems bizarre than in one of the richest countries on the planet there are substantial numbers of people who have good reason to fear the ruination of their family finances if they become seriously ill and run out of the limited health cover which is all they can afford - if they can afford anything, that is.

There is of course always a trade-off between the potentially limitless demands of each individual for health care (basically we all want to live for ever) and available resources, but in few other advanced countries do individuals face such a sharp and socially unsupported confrontation with the 'medical expense cliff' as can happen in the States.

[_Shiloh]

We will see how it shakes out and what inevitable pains result from such a big change.

Agreed. It will be interesting to see both the benefits -- of which there are sure to be many -- as well as the unintended consequences (of which we should expect to see at least a few) of Obamacare.

But the pre-emptive firings and downsizing I see happening look more like tantrums than any serious attempt to work within the new rules. I think creative and ethical people will find a way to succeed without being jackasses. But we will see.

Agreed. There is no way to fully anticipate the costs/benefits until we see Obamacare in action.

Maybe the Republican shouldn't have pushed out the public option/single payer ideas.
Afterall, there do exist extremely competative ans successful businesses in all those countries with universal healthcare. Many successful and big businesses/corporations are located in countries we would accuse of being "socialist". Maybe they will out compete us -ironic.

Excellent point. High health care costs do put American businesses at a disadvantage -- but single payer systems create their own problems. Nothing comes for free. Someone is going to have to pay more and what Obamacare does is shift money around as no new wealth is being created. I'm not saying this is a bad thing. But when I hear some people (certainly not you) talk about how Obamacare is going to bring about all of these sweeping benefits I rarely hear a consideration of the increased costs. You can't do things like mandate birth control coverage or that insurers keep kids on a policy until they are 26 without raising costs -- significantly. You alter the cost structure of insurance companies and their customers. Was it really wise to introduce what amounts to a very large cost/tax increase to both businesses and individuals in the midst of the worst economic downturn since the GP? Just as we are seeing the job market heat up again, a huge new cost is being introduced. If anything, I think Obama should have focused on getting unemployment down -- though a better use of the stimulus or some other means -- rather than focus on a major financial and social shift in how healthcare is delivered. Don't get me wrong. Reforms are absolutely necessary. But are these the right reforms done in the right way? We'll have to wait and see.

Oh and I would certainly be willing to pay a few more cents or even a dollar more for pizza--especially if it didn't taste like warmed over social despair.

As would I. But we are fortunate to be able to afford to pay extra. My concern is that this extra cost that in most cases will be passed on to consumers, means that I'm paying more money for the same goods/services I had before. Now, I just have less cash in my pocket to spend elsewhere. Hopefully the extra I pay will funnel its way back into economic growth by providing for more healthy individuals etc... But hell, it has to go though about 18 layers of bullcrap before that happens.

I'm hopeful .... but feeling cautious until I see how this all goes down.

[_Shiloh]

You are wise, Shiloh, to see the limitations of legal advice found in the pages of the WSJ and NY Times.

Hi SP --

Thanks for your expert legal opinion! Very insightful and helpful.

[_harmony]

I think creative and ethical people will find a way to succeed without being jackasses.

I think there are very few creative and ethical business people, period. I think it's virtually impossible to find them and it's stupid to expect to find them.

While I have little use for unions, there may come a time in the near future when we again see the rise of group efforts in order to force people to act ethically.

[_Shiloh]

I think there are very few creative and ethical business people, period. I think it's virtually impossible to find them and it's stupid to expect to find them.

This is, without a doubt, one of the stupidest things I've read on the Internet, ever.

Most business people are honest hard working men and women. You are letting the bad apples give you a really skewed view.

[_Chap]

... I have little use for unions ...

.

In historical terms, I can only say "lucky you". Any human institution can go off track and become a problem instead of solving the problems it was founded to address. They can be captured by evil people, and be used for bad ends. That can happen to unions, and has certainly happened to several of them.

But the idea that the employers of industrial labor from the 19th to the 20th centuries would have offered their workers decent wages and safe working conditions without those workers banding together in unions that had the power to bargain on equal terms with the big bosses is ... well, overly hopeful about human nature. And there are still plenty of places in the world - even perhaps places in the US - where employers can treat their workers just as they wish because there is no-one to speak out to them on a basis of countervailing power. That is of course one reason why the Chinese government does all it can to ensure that its industrial masses, labouring under sometimes hellish conditions to build stuff for Americans to buy, never get round to organizing themselves into a trade union that is not merely a government controlled puppet organization.