April 25, 2010

The Lousy House



On a crisp April day, I returned to my home town for the first time in 38 years. Riverside Connecticut, a subsection of Greenwich, sits on the intersection of the Mianus River with Long Island Sound. It was a wonderful place to grow up; it was solidly middle class with teachers, plumbers and commuters all living side by side. Today, houses which sold slowly for 40 grand in 1970 easily top seven figures now. It has evolved into an exclusive retreat for the wealthy commuters to NYC. The old Colonial and Victorian houses, which were usually in intermediate degrees of decrepitude with peeling white paint as their common feature, sport 4 color fresh paint schemes, shake roofs, spectacular landscapes and real ambiance.

I was lucky in my timing as the daffodils. tulips, dogwoods, cherry trees and crab-apples were all in riotous display. One could not have asked for a more opportune return to one's childhood.

Sitting among this splendor was the biggest shock of all--the survival of the "lousy house". The lousy house was (and is) a small variety store that sits about a hundred yards from the railroad station. It sold (and still sells) penny candy, cigarettes, newspapers and simple groceries like bread and Twinkies. It never had a sign out front; it never advertised; and it never even had a real name. Kids would flock there after school on their bikes; they would buy penny candy from a large oak display case, sodas from a water filled cooler in the back for seven cents or snow cups for a dime. Your mother might send you there for a 25 cent pack of Pall-Malls or a 27 cent loaf of Daffodil bread. It has a front porch where kids would sit and eat their loot or blush at the arrival of the opposite sex. I have no idea why it was called the lousy house because there was nothing wrong with it.

So, with no "branding", no advertising, and no marketing, there stood the lousy house in all of its former glory just as I had last seen it almost 4 decades ago. I had to go in. The place was pristine in its originality. The oak display case was still there...still full of penny candy (which now costs a dime). The water cooler for the sodas was gone but the grabber, the mechanical device used to grab items from the top shelves was still there on its hook in the corner. The newspaper tray was still there as I had remembered it.

Most conspicuously absent was Ada, the lady who ran the joint. She knew every kid in the neighborhood (and wouldn't think twice about calling your parents if you tried to buy some cigarettes). She also knew every piece of gossip in town. Her nephew, who now tends the shop, explained that she had died two years ago at age 87. She had worked the place well into her seventies. He told me that old "clients" had dropped by fairly often; that she had remembered most of them; and, that all of them, like me, were shocked that the old place still existed. I was sorry to have missed her.

Also conspicuously absent were the kids. While my generation rode bikes everywhere and generally ran wild, the new generation is home watching tv, playing on the internet or texting their smart phones. Despite the resilience of the lousy house, the old neighborhood had a distinctly different feel to it.

It is remarkable to consider what survives and what does not as progress marches inexorably forward. Without Ada, it is hard to believe that the lousy house will last much longer. I know that it was the high point of my return to my home town--kind of a Rosebud moment. Such moments do not come often and need to be cherished.

April 8, 2010

Skin in the Game

Back in the early 1970's, I did research on neurotransmitters at Massachusetts General Hospital in Boston. Our group collarorated with the Department of Psychiatry. One day while shooting the bull with some post-doc Psychiatry fellows, I asked them what their favorite Psych study was. Several of them mentioned a study which demonstarted that patients get a lot more from their cognitive therapy (counseling) if they actually pay something, even a small fraction, for it. If it were completely free, they did not value it. This little conversation stuck with me.

There is much talk today about moral hazard; the idea that if a third party pays for a service, it is misused or abused. Investment Bankers take excessive risk if they know the public will bail them out. Patients want more health care, even unnecessary health care so long as an insurance company pays for it. The list is endless.

People have been able to buy half million dollar homes with no money down; those with any equity have sucked it out. Having no equity in a house sure makes it easier to mail in the keys and walk away.

My 16 year old daughter had a summer job punching a cash register at the local grocery store. She came home with stories of the fine meats, expensive cheeses and name brand products that people were buying with food stamps--better stuff than most upper-middle class families could afford.

I recall, as a practicing physician, having difficult end-of-life discussions with family members about how aggressive to be with terminal aged loved ones. Many responded that I should do everything possible so long as the insurance paid for it. I love the ads on TV that promise that they can get you a power chair (to get your lazy butt out of the chair) or a scooter (to get your lazy butt around the house) without costing you a cent. While there are legitimate uses for these things, for most patients, the increased inactivity, enabled by these expensive devices, actually reduces health. The power of free is incredible.

The popular book—Predictably Irrational documents the Hershey kiss experiment. The experimenters offered students a Lindt Truffle (very high end chocolate) for 26 cents or a Hershey Kiss for 1 cent. 40% chose the Lindt Truffle while 40% chose the Hershey Kiss. The price of each was dropped one cent and the choices were repeated. In that instance, the subjects chose the kiss 90% of the time. Despite the fact that the price was dropped equally, the “freeness” of the kiss seemed irresistible. Impressively the experimenters tried various other combinations but were unable to avoid the power of “freeness”.

Goldman Sachs was a privately run firm until the 1990's; when it invested in something, it was using the partners' capital--capital that could only be taken out slowly, even after retirement. They were all on the hook personally. Once they went public, they were betting the shareholders capital. Do you think management's tolerance for risk increased?

All of these examples underscore the incredible changes in behavior that are explainable by moral hazard. Perhaps the answer to many of the ills presently effecting society is to substantially reduce moral hazard at all levels. Let's go back to requiring a 10-20% down payment on mortgages (and all loans). Let us require people with food stamps to pay 20% of the cost. Let us require credit default swaps to be limited to insuring a maximum of 80% of the value of the bond in question. Let's require insurance (in total) to cover only a maximum of 80% of the cost of a medical procedure. This simple concept is known as having "skin in the game"; it forces people to actually seriously consider how they use resources--something sorely lacking in today's society. Just as the Hersey kiss experiment showed us, even a small cost makes people more rational and more responsible in their choices.