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The Terror of the Broccoli

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James Stewart’s article about how the “broccoli mandate” went from particularly dumb winger talk-radio fodder to being taken seriously by the Supreme Court of the United States isn’t bad, although it would have been nice if he had given some space to the people who disagree with it to explain why it’s wrong rather than just permitting them bare assertions.

The necessity of a slippery slope argument in trying to argue that the tax penalty for not buying insurance is unconstitutional is obvious for the same reason it fails: the argument is particularly weak as applied to health care because nobody “chooses” not to participate in the health care market. The rare person who chooses to be uninsured (as opposed to having the choice thrust upon her) is just free-riding and cost-shifting, precisely the type of problem the commerce clause was designed to allow the federal government to solve. And yet, it seems to me that the broccoli mandate doesn’t take full advantage of the fact that slippery slope arguments, like dreams, are totally free. If you trying to terrify people with policies that have no chance of being enacted to distract from the farcical weakness of your argument, can’t you come up with something a little scarier than being compelled to purchase a nutritious vegetable that, as Sarah Kliff notes, Americans tend to like? Given that the America government can already do much scarier things, this being the bottom of the slippery slope becomes self-refuting.

And yet, there is something about it that taps into a particular segment of American culture. I am reminded of this gem from Ben McGrath’s far-too-credulous Lenny Dykstra profile:

Dykstra asked me to order him a wedge of iceberg with blue cheese, and excused himself to go outside and chat. By the time he returned, the piano player had started his set. “Brutal—can’t take this,” Dykstra said. We moved to a table on the opposite side of the restaurant. After some consultation with her manager, the waitress informed Dykstra that the Four Seasons didn’t offer iceberg lettuce. “I do have romaine,” she said. “Would that be O.K.?”

“Give me a cheeseburger,” he said.

I suppose that to people who are only willing to have a salad only on the condition that the base ingredient be entirely devoid of nutrients, the mythical “broccoli mandate” is pretty much the scariest thing they can think of.

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  • j_h_r
  • Joe

    There is something immature about use of broccoli as a scare tactic. More evidence that some really, per The Princess Bride, don’t want to be (wo)men of action, but children who don’t have mature arguments.

  • Malaclypse

    I will tell you where this slippery slope ends: last year, my wife bought matching t-shirts for my daughter (then age five) and I. These t-shirts were bought as vengeance for the fact that daughter and I like broccoli, wife does not, and I kept serving it.

    Said t-shirts were bright green, with a picture of a giant be-faced broccoli, with the caption “Yay Broccoli!” underneath, and every weekend last summer, the darling daughter would insist that we both wear said shirts so that we could match, like a team.

    Had said darling daughter not grown like a weed, my only hope to avoid repeating this fate would be Antonin Scalia.

    • Joe

      I love it.

    • DrDick

      I hate to bring this up, but it does cause me to question your taste in women.

  • md rackham

    Some of us like crisp water with our bleu cheese instead of the limpness that is romaine.

    Plus, he probably got iceberg on his cheeseburger.

    • Halloween Jack

      It’s not like there aren’t about a trillion places in NYC where he could order iceberg lettuce by the head; one doesn’t go to the Four Seasons for stuff that you can get at McDonald’s.

  • Halloween Jack

    The whole thing with kids hating broccoli isn’t about whether or not they actually like it, it’s about whether or not they can say “no” to it. That applies to superannuated kids like Dykstra, who (even according to this story) liked to bully the help, but was as irresponsible as a person could be.

  • David M. Nieporent

    Once more: insurance is cost-shifting. And getting government-subsidized insurance is both cost-shifting and free-riding. The mandate doesn’t “solve” the problem of cost-shifting and free-riding; it expands it.

    • Malaclypse

      Shorter David: If the solution to a collective action problem involves government action, then I will define the solution as a bigger problem, and act like this is a valuable insight.

      • j_h_r

        Also: contra Abraham Lincoln, if David M. Nieporent redefines a dog’s tail as a leg, then the dog really has 5 legs.

      • NonyNony

        Even shorter David: Republican solutions to problems enacted by Democrats are bad.

        • David M. Nieporent

          Most “Republican solutions” are indeed bad.

          Although I did like the awkward phrasing of “problems enacted by Democrats.”

        • timb

          There is no Republican solution to this problem. Nieporent is a nihilist

      • David M. Nieporent

        Shorter Macalypse: “Duh… economics is confusing.”

        • Malaclypse

          Shorter David: libertarianism isn’t a joke, so why are you all laughing?

          • timb

            Unless I need tort law claims to make money for my law firm, then government’s enacting of negligence laws and maintenance of the Courts is a good thing. Otherwise, government sucks….except to enforce my judgments

    • rea

      Insurance is only cost-shifting and free-riding if looked at in hindsight–at the time you buy insurance, it isn’t cost-shifting or free-riding.

      • David M. Nieporent

        I didn’t say insurance was free-riding; I said that government-subsidized insurance was.

        As for cost-shifting, there’s a sense in which ex ante buying insurance isn’t — but in that same sense, “choosing not to have health insurance” isn’t cost-shifting either, contra Scott’s post.

        • I didn’t say insurance was free-riding; I said that government-subsidized insurance was.

          And, as I documented above, you were very wrong to say that.

          As for cost-shifting, there’s a sense in which ex ante buying insurance isn’t — but in that same sense, “choosing not to have health insurance” isn’t cost-shifting either, contra Scott’s post.

          Again, as documented above, it is exactly that (and it is cost-shifting in a problematic sense). It shifts the cost of care onto the smaller sicker pool (if funded by premiums) or onto the taxpayer at large (if the care is funded by e.g., Medicad or emergency rooms). If the latter, we might as well put it on better terms (i.e., get more health bang for our taxpayer buck).

          (This is all aside the immiseration and stress lack of health insurance brings.)

          • Apparently my documentation is below :)

            I guess David didn’t want to be taken seriously.

          • David M. Nieporent

            It doesn’t “shift” the cost of care onto the “smaller sicker pool”; the sick people are the only ones for whom there is any cost of care.

            If you don’t use care (or if you pay for the care yourself out of pocket), then there’s no cost to shift.

            • You start with a pool of participants paying for insurance.

              You introduce a no-refusal for pre-existing conditions.

              Occurrently healthy people drop their coverage, thus removing their premiums.

              The cost for the care of the sicker people is shifted from a large pool that includes healthy people to a smaller pool consisting of sicker people.

              The cost for risk mitigation is also shifted from the larger pool which include healthy people to the smaller pool of sicker people.

              Of course, the real point is that we pay for this care either way. Having everyone in coverage is in aggregate cheaper and more effective than having people out of coverage, for whatever reason.

              • Donna Gratehouse

                Do healthy people regularly drop generously subsidized health plans they get through their employers? The only reason I have ever seen someone drop insurance is because they could no longer afford the premiums and/or the out of pockets were so high they couldn’t afford to use the insurance.

                • Well, typically either you can’t really drop it (it’s part of the structure of your compensation), or there’s no real benefit and, of course, you’re screwed if something goes wrong.

                  The “you’re screwed if something goes wrong” is, indeed, a powerful incentive.

                  Removing pre-existing condition refusal removes that incentive. And in places (like Washington state) where that combination occurred, people did in fact drop their coverage with the full intent of buying back in only when they got sick.

    • Scott Lemieux

      Once more: insurance is cost-shifting. And getting government-subsidized insurance is both cost-shifting and free-riding.

      Wrong, and wrong again.

      • DrDick

        Well that really is the answer to all of David’s statements.

    • This only works if we don’t use “free-riding” in a technical sense. And in that one sentence I’ve already wasted too much time on you.

      • Ah, if I had only read this comment first, I could have avoided wasting far more time!

      • David M. Nieporent

        That’s the kind of argument I’d expect from a Yankees fan.

        • DrDick

          More of the substantive, well sourced arguments we have come to expect of you.

    • I’m trying to understand this and failing.

      Let me tackle free-riding first. I think you have to be equivocating on the term: If someone cannot afford insurance and is subsidized to purchase insurance, then in neither case are they a free rider in the classic sense of the term (i.e., as the problematic figure in collective action). It’s not the case that they could have contributed and didn’t while still getting the benefit. They couldn’t have contributed due to lack of resource.

      In both cases (subsidized insurance or charity/subsidized care), these people receive a subsidy, but in once case (insurance) the result is typically cheaper, less piecemeal, more dignified, and more effective. Changing how we subsidize doesn’t change the number of people receiving such subsidies (though it might change the precise mix of benefit…which is part of the point! e.g., toward preventative or early intervention and away from emergency room care). Thus, it cannot expand the set of “free riders” (even in your mistaken sense).

      In a regime of no mandate and no refusal for pre-existing conditions, there is a clear incentive to free ride. Suppose I’m currently healthy. I have no incentive to pay for insurance because I don’t right now need it and I can get coverage as soon as I need it. But insurance depends on having a wide pool of subscribers (usually with a smaller percentage needing care). The people who are free riding are those who could pay premiums and don’t and don’t need care. Those who need care aren’t freeriding…their past premiums typically wouldn’t cover their medical expenses. The people who are benefiting from the reduction of risk without the costs of such reduction (when they could cover it) are free riding.

      In the current regime, those who are healthy and forgo insurance and can afford it are free riding in exactly the same way. Since uninsured people tend to forgo non-critical health care, this makes that population sicker than they would otherwise be, which makes the consequences of that populations free riding even worse.

      (Free riding isn’t always a problem, of course. If tax avoidance or cheating or benefit cheating is low enough, it may not damage the system. You don’t need to catch every cheat, or even any cheat…you just need the culture to be sufficient that free rider spirals or other associated problems don’t emerge.)

      Similarly, for cost shifting. If we use it neutrally, i.e., just as a change in the cost distribution from a prior state, it isn’t necessarily bad. In ACA terms, the problem is, again, moving the costs onto a smaller pool of sicker people. Sicker means larger costs and smaller means spread over fewer people. Thus premiums are higher. This causes people at the margin (poor enough or not quite sick enough) to forgo insurance leaving a yet smaller and sicker pool. The adverse selection spiral destroys that pool. With the ban on refusals based on pre-existing conditions, we shift the cost onto the smaller, very much sicker pool. With the mandate, we shift the cost over a wider, less sick pool. The latter works and works well. It’s just because the risk mitigation benefit is shared over all the beneficiaries.

      So, you are completely wrong about free riding and very very very confused about cost shifting, at best.

  • Snarki, child of Loki

    We have to fight the broccoli menace over here, so that we don’t have to fight it over there.

    Wait, that came out wrong.

  • jpe

    The broccoli argument isn’t a slippery slope, it’s a reductio ad absurdum. No one is contending that the broccoli police will show up at your door someday.

  • Ivring Laitu

    Ah, the old “eating iceberg lettuce is like eating cardboard” meme. The peculiar segment of American culture that is proud of itself for avoiding iceberg lettuce.

    Try googling up iceberg lettuce and comparing nutrition stats. Plenty of romaine debunkers out there, and some of them might not be crazy. One guy normalizes by calories and gets a pretty good fit between iceberg and romaine.

    Either way, you’re not going to get big and strong by eating lettuce or broccoli. For that, puculiar American segments, you need BEEF.

    • I’ve become quite enthusiastic about iceberg in Szechuan dishes. It’s really quite lovely in a spicy sauce.

    • Scott Lemieux

      Romaine isn’t much better than iceberg in terms of nutrients, true, but it is better.

      I make no special effort to avoid iceberg lettuce; I had a very nice iceberg wedge recently. But I never buy it, because are tastier greens that provide far greater nutritional value.

  • CJColucci

    I don’t know why, under the Commerce Clause, Congress can’t make you buy broccoli. Dumb idea, really dumb idea, but not unconstitutional. What Congress can’t do, thanks to substantive due process, is make you eat it.

    • rea

      We’ve had a system of tax-funded agricultural price supports for decades, and nobody seems to think that’s unconstitutional. The distinction between that and mandatory purchase of agricultural products is not easy to see.

      • (the other) Davis

        Since I’m currently neck-deep in bar exam studying, I feel compelled to point out that agricultural supports are clearly allowed under the Taxing and Spending Clause. Mandatory purchase of agricultural products would probably rely on the Commerce Clause for its authority (I’m too lazy to thoroughly research this at the moment, but I’m struggling to see how this would be characterized as a “tax”) — with all the incumbent silliness that the Commerce Clause tends to evoke from the libertarians and wingnuts.

      • timb

        Unless you are Judge Scalia and really, really WANT to see it

  • “I’ll have an apple juice.”

    “We don’t have apple juice, sir.”

    “In that case bring me a vodka and tonic.”

    • Malaclypse

      Vodka and tonic? What the hell is wrong with you?

      • Gin is my drink, but I’m not going to mess up a 30 Rock quote over it.

  • Sebastian H

    “the argument is particularly weak as applied to health care because nobody “chooses” not to participate in the health care market”

    This is a particularly weak argument in response to the broccoli hypothetical because even fewer people ‘choose’ not to participate in the food market than choose not to participate in the health care market.

    And the slippery slope argument doesn’t really apply either. The anti-mandate people are suggesting that from a constitutional point of view this is the bottom of the slope, if you can mandate the purchase of items it is just a matter of whether or not Congress chooses to.

    Compare that to an argument about torture. It is one thing to argue about what counts as torture (the evil Bush memos). It is another entirely to argue that torture is perfectly legal, but the Administration should just be trusted (because of various political pressures or whatever) not to use torture inappropriately. The first is putting you on the slippery slope to legalizing torture. The second has already legalized it, you are just arguing that the government has not ‘yet’ gone too far in using its legal power. (See neo-liberal discussions of drone assassinations of US citizens).

    • This is a particularly weak argument in response to the broccoli hypothetical because even fewer people ‘choose’ not to participate in the food market than choose not to participate in the health care market.

      So broccoli:food::health insurance:health care?

    • Scott Lemieux

      This is a particularly weak argument in response to the broccoli hypothetical because even fewer people ‘choose’ not to participate in the food market than choose not to participate in the health care market.

      Except that if you refuse to participate in the food market other people are not therefore required to pick up your expenses.

      The anti-mandate people are suggesting that from a constitutional point of view this is the bottom of the slope

      Those that are saying that are wrong. 1)They wouldn’t use these other examples if the liberty to not have to pay a tax penalty if you free ride in the health care market wasn’t trivial, and 2)it’s not actually the bottom of the slope, since the commerce clause restrictions placed by the Rehnquist Court would remain in place.

      Your torture analogy is odd for a lot of reasons, but one reason it fails is that the checks on legislative power are much greater than the checks on executive power.

      • chris

        Except that if you refuse to participate in the food market other people are not therefore required to pick up your expenses.

        Well, to be fair, I’m sure plenty of the people against Obamacare would love to repeal EMTALA too, and just let the poor die in gutters as Ayn Rand intended.

        • David M. Nieporent

          No; we assume that generous and compassionate people such as yourself would voluntarily pay for their treatment, because you care so much.

          Ha! I almost got that one out with a straight face. We all know “liberal” = “being charitable with other people’s money.”

          • Malaclypse

            We all know “liberal” = “being charitable with other people’s money.”

            Also, we all know that libertarian = not understanding the entire category of collective action problems.

            • DrDick

              Or much of anything else in the real world.

            • Also, since I pay a higher effective tax rate than Mitt Romney it’s not clear how this is about “other people’s money.”

            • David M. Nieporent

              Back to that “Duh… economics” thing again. Just because you read a column in the Nation which criticized classical economics and used a fancy-sounding term like “collective action problem” does not mean you know how to apply it.

              This is not a collective action problem.

              • Malaclypse

                This is not a collective action problem.

                Thank you for proving my point so clearly and succinctly.

                • timb

                  +1

                  Medical coverage is not a collective problem

              • How can you possibly be talking about free riders in this context and not be talking about a collective action problem?

                I mean, how?

                The “duh economics” does seem appropriate.

                The collective good is “not being at risk of lack of care should we be injured or fall ill”. The individual effort is paying premiums/tax/mandate penalty.

                It’s…textbook. Really, it is.

                • Malaclypse

                  How can you possibly be talking about free riders in this context and not be talking about a collective action problem?

                  Because David is nowhere near as bright as he believes he is.

                  That really is the most likely answer.

      • bradp

        Except that if you refuse to participate in the food market other people are not therefore required to pick up your expenses.

        But if you refuse to engage in the food market reasonably (say, having a diet that consists of only stricklean and coffee), there is a high chance of forcing other people to pick up the tab. And if you really want to dig in, the mechanism for passing the costs of a poor diet on other people is through spiraling health insurance prices because of information assymetry between insured and insurer.

        The analogy between mandated insurance and mandated diets is pretty apt.

        • Actually, it’s completely incoherent.

          Try to starve yourself to death. In most cases, you’ll be forcibly fed.

          Try to consume human flesh…you’ll be in trouble.

          Try to consume poison, if you survive, you’ll face penalties.

          Etc.

          Acquiring adequate food (to survive) is prompted by immediate and very difficult to override biological prompts. There’s no free rider problem here.

          Eating “the right” kind of food for optimal health is a different issue and very much not like the mandate.

          These aren’t every remotely close!

          • bradp

            Eating “the right” kind of food for optimal health is a different issue and very much not like the mandate.

            Bull. The worse the diets, the more expensive the health insurance.

            And since health insurance companies have incomplete knowledge of their clients dietary habits, they will always be forced to raise insurance prices, in effect subsidizing thos with poor eating habits at the expense of those with good eating habits.

            • Malaclypse

              Yes. This is knows as “spreading risks.”

              • bradp

                It is also free-riding on an information assymetry on the part of the people with bad diets. Very much the same problem that causes the “health insurance death spiral”.

                • Malaclypse

                  And in both cases, the information assymetry can only be truly solved by universal coverage.

                • bradp

                  And in both cases, the information assymetry can only be truly solved by universal coverage.

                  I don’t think you can call it truly solved, but yes, you keep the system in tact by forcing the low risk, healthy eaters to support the free-riding of high-risk, unhealthy eaters.

                  Like Neiporent said, you keep the system going by making one group absorb the cost-shifting or pay a fine equal or greater than the cost that the refuse to absorb.

                  Now, truly solving the problem would be enforcing dietary constraints so that health insurers can have some confidence in the accuracy of their risk calculations.

                • “free-riding on information asymmetry”??

                  This makes no sense. Do you mean “information asymmetry provides opportunities for problematic free riding”?

                  There are all sorts of risks that the population experiences. Many of them are well understood (auto deaths and drunk or text drivings, mitigations like seat belts, high way construction, and speed limits); many are not (many diet and life time health connections).

                  There no easy sense in which people who engage in normal activities are free riding their health care. Certainly not in any way that is analogous to possible unmandated free riders.

                  Again, sans mandate and avec universal acceptance, the temptation is to opt out of insurance until (or only if) one needs care. The freeriders are the ones who don’t get sick (in some given period).

                  If you eat unhealthily or smoke you may end up in a higher risk pool, but you aren’t free riding (esp. if you pay in!).

                  It’s just a different issue altogether.

            • Bull. The worse the diets, the more expensive the health insurance.

              I don’t think you were supposed to announce the bullshittery of what you subsequentely write.

              Even if this made any direct sense, there’s still no analogy. When you opt out of insurance, you opt out of the thing all together. You never opt out of food altogether without being immediately coerced. Just because something might make insurance more expensive because it might make health costs more expensive does not make it interestingly analogous to the specific way that free riding makes health costs (and thus, insurance) more expensive.

              Really, there’s absolutely no joy to be had here other than the amusement your antics provoke.

              • bradp

                Just because something might make insurance more expensive because it might make health costs more expensive does not make it interestingly analogous to the specific way that free riding makes health costs (and thus, insurance) more expensive.

                Do you understand what makes the health insurance industry so difficult to price out?

                Health insurance companies do not have adequate information to accurately price health insurance policies. Because of this, they have to raise prices on those with less risk to make up for undershooting on those who have more risk. The result of that is a low-risk flight from pools that contain high risk individuals.

                Because the problem is inherent to the pooling of people with different risks, as more low-risk people drop out, insurance companies are forced to further raise their prices, providing the incentive for more customers to drop out.

                The entire system, because insurance companies cannot accurately judge risk levels, trends towards impossibility.

                Any behavior that is risky relative to the other members of the pool will contribute to the problem. Unhealthy diets are the most basic and probably the most important factor to the extremely divergent health and risk levels we see in our society.

                It is perfectly analogous, and I believe to argue otherwise is very disengenious.

                • Malaclypse

                  The entire system, because insurance companies cannot accurately judge risk levels, trends towards impossibility.

                  Well, that, or some sort of universal coverage.

                • DrDick

                  Health insurance companies do not have adequate information to accurately price health insurance policies. Because of this, they have to raise prices on those with less risk to make up for undershooting on those who have more risk.

                  There is no way to reliably estimate the lifetime medical expenses of any individual. Insurers can and do collect very detailed and accurate aggregate information on a wide variety of reasonably fine grained demographic groups (see Actuary, Insurance). From that, they can infer the probable average lifetime cost for members of those groups (40 year old married African American males in the building trades who smoke and drink moderately for instance).

                • bradp

                  Well, that, or some sort of universal coverage.

                  Yeah, of some sort. And I think you are aware that I’m at least sympathetic to universal healthcare. I would just rather see government handle the expenses (actually the provision) directly for those with high-risk profiles, rather than engineering a penalty that is great enough to force others to buy a health insurance product that will be almost guaranteed to not be worth the money.

                • Malaclypse

                  So would I, but I won’t let the perfect be the enemy of the barely adequate.

                • bradp

                  So would I, but I won’t let the perfect be the enemy of the barely adequate.

                  There were other solutions on the table. The democrats didn’t have to go single-payer or POS handout to insurance companies.

                  And immediate sea change was unnecessary. The implementation of a need-based public option, and a real investment in Bernie Sanders community health centers would have been a good start. Going that way would have at least provided government administrators some direct market data before they turned the game over to the insurance industry.

                • Do you understand what makes the health insurance industry so difficult to price out?

                  I understand that you are fond of non sequiturs.

                  Health insurance companies do not have adequate information to accurately price health insurance policies.

                  Their existence and profitability suggest otherwise. If you mean that they can’t do extremely fine grained targeting of precise price levels to exact individual risk, well, duh. No insurance company can do that, nor do they want to.

                  Because of this, they have to raise prices on those with less risk to make up for undershooting on those who have more risk.

                  At this point, the charitable move is to assume that you’re trolling.

                  This is a very confused way at best to look at things.

                  Because of this, they have to raise prices on those with less risk to make up for undershooting on those who have more risk. The result of that is a low-risk flight from pools that contain high risk individuals.

                  You do understand that this only happens if 1) the price is sufficiently high or 2) in the absence of a mandate?

                  I obviously understand the adverse selection death spiral as I articulated it already in this thread. Repeating it doesn’t make your case any better.

                  Any behavior that is risky relative to the other members of the pool will contribute to the problem. Unhealthy diets are the most basic and probably the most important factor to the extremely divergent health and risk levels we see in our society.

                  Two amazingly silly things in as many sentences. First, none of this is free riding or a free riding problem. The problem of costs is just that, a problem of costs. Factors that increase the total costs whether voluntary or involuntary (or somewhere in between) are all similar in nature. They are all rather unlike the opt out free riding problem. Even when these interact, they interact in different ways. Opt out free riding’s big effect is shrinking income not increasing the outgo. Riskier behavior increases the outgo. There are usually sufficient incentives for people not to get sick that we don’t have to worry about engaging in more risky behavior because they have insurance (though there are such effects, e.g., eating something healthy increases your likelihood of eating something unhealthy because of the protective halo). They engage in risky behavior for a variety of complex factors.

                  I would very much like to see data that diet is the major driver of diverse risks esp. when compared to, oh, I don’t know, age.

                  If you want an analogy, the much better one is mandatory vaccination (which, oops, actually happens!). There you are forced (or strongly encouraged) to undergo physical invasion for the sake of lowering the general risk (both directly and indirectly). People want to opt out of it for a variety of reasons, esp. as long as they can benefit from herd immunity. That is a classic free rider problem. It’s obviously not an insurance failing problem, but the relevant structure is the same.

                  It is perfectly analogous,

                  I have to conclude that you just don’t know what “analogous” means.

                  and I believe to argue otherwise is very disengenious.

                  To be called a liar by a fool doesn’t bother me all that much

                  I’ve articulated several times how these things are disanalogous. All you’ve done is to say that increasing costs might raise premiums and thus increase the incentives for low risk people to leave. This is not the remotely analogous to allowing low risk people to benefit from the risk mitigation of coverage while not requiring them to pay in.

                  This is so sad.

                • You’re correct that single payer is a better way of solving the underlying collective action problem. Since the Constitution doesn’t require Congress to adopt optimal policy choices, however, the relevance of this to the constitutionality of the PPACA remains unclear.

                • bradp

                  Bijan, you are not a liar, and I’m not a fool. You are just an arrogant twat who won’t concede an inch or abandon the hostility even when you find nothing to disagree with.

                • bradp

                  You’re correct that single payer is a better way of solving the underlying collective action problem. Since the Constitution doesn’t require Congress to adopt optimal policy choices, however, the relevance of this to the constitutionality of the PPACA remains unclear.

                  I’m just trying to show that diets create an information asymmetry similar to the one that creates the “death spiral”. In fact, I would think that variances in diets would be a large component of the information asymmetry. Insurance companies know your age, whether you smoke, heredity issues, and medical history, but they can’t know that you eat 10 big macs a week.

                  The constitutional hinges on an question so narrow to make it pointless.

                  I also think the context of the debate makes it look like liberal progressive types are more concerned about dietary controls than they are.

                • Bijan, you are not a liar,

                  Well, I know this. But you called me disingenuous. Perhaps you also don’t know what that means?

                  and I’m not a fool.

                  This is more open.

                  You are just an arrogant twat who won’t concede an inch or abandon the hostility even when you find nothing to disagree with.

                  My hostility is to your persistent foolishness on the one hand and your condenscending insults on the other (“bull”, “disingenuous”).

                  You say that the insurance mandate and the threat of coerced broccoli eating are interestingly analogous. I’ve extensively and, I believe, correctly, argued that they are not. This seems to be a point of disagreement. I seem to have found it.

                  I have no idea why you persist in this obviously bogus line. But I don’t know why you so often do it. You’ve been totally unresponsive to all my points.

                • Oh, brad, I’ll just add that it’s rather amusing to be called arrogant by someone who just made the argumentative move that anyone arguing against their line is disingenuous.

                  I don’t know whether you’re being disingenuous. My speculation is that you are just wrong and stubborn about it.

    • Joe

      The issue here isn’t “food” but a certain type of food in particular. Many people choose not to enter the broccoli market.

      A reply to the “slippery slope” argument is even if they can mandate purchase (1792 Militia Act etc.), there are various ways to differentiate along the slope. The antis generally admit sometimes you can mandate purchase. Just not here. Not that the law even mandates purchases. It to some degree penalizes lack of coverage, for some people.

      The torture example seems inapt in this context; too much baggage, for one thing.

  • I’m simply stunned at how a rather straightforward concept as the free rider problem can be so misunderstood with such brash assurance.

    “Free rider” doesn’t mean that one person pays less (or nothing) than another. The “free rider problem” isn’t that there are instances of free riders (or non-payers) in some system. It just doesn’t.

    • bradp

      If you pay less than your fair share to enjoy a collective set of resources causing others to pay for a portion of your enjoyment you are a free rider.

      If you buy into an insurance pool, and you have a diet that makes you more risky than your premium accounts for, and someone else must make up the difference by paying a higher premium than their risk would dictate, then you are a free rider.

      The hedge against the risk of illness and injury that health insurance provides is a common resource amongst the policy holders. When one of the common holders of that hedge begins to eat an unhealthy diet, because the insurance provider cannot accurately guage that, the cost is placed upon the healthy dieter.

      • If you pay less than your fair share to enjoy a collective set of resources causing others to pay for a portion of your enjoyment you are a free rider.

        A lot hinges on “fair share” there. But even if we grant this, there is still a critical difference between having free riders (or, better put, having subsized participants) and having a free rider problem.

        If you buy into an insurance pool, and you have a diet that makes you more risky than your premium accounts for, and someone else must make up the difference by paying a higher premium than their risk would dictate, then you are a free rider.

        Let me try to be charitable, though until you look up “disingenuous” I’m pretty sure you don’t deserve it: This line, at the very least, needs unpacking. What is “risky than your premium accounts for”? You need some idea of the relevant pool. The pool could be “adult American males” or it could be “adult American males with a certain BMIs”. You can slice the pool in a wide variety of ways. For profit, you want to cut out as many of those with higher identifiable risk or at least price them differentially. For coverage, you want to have as wide a pool as possible with costs spread out over all. So, the “risk your premium accounts for” is not an individualized risk, at least in any inherent sense.

        Note that on your, shall we say, “model”, sick people are inherently “free riders”. Their risk is 1. Thus, any care over their premium is free riding. Yes this is a reductio of your position, one of many. For example, someone with an unhealthy diet who never consumes any health care in their lifetime. Their risk (we now know) was 0. Yet they paid!

        Now, even if we grant that these people are failing to contribute…what, healthy behavior? to the collective good, it’s still a big stretch to this aspect of their behavior generates a free rider problem. Eating crappily isn’t something that response to the presence or absence of insurance, particularly. Even if you grant your ridiculous and unsubstantiated presumption that we have solid, determinate knowledge of the relation between diet and health risk in any reasonable way (I’m not saying we have no knowledge or there’s no control but any reasonable person would admit that it’s horribly complicated as the margine fiasco shows), it’s just not the case that “healthy eating” is the kind of straightforwardly voluntary behavior with direct benefits and costs to the system that forgoing insurance is. It’s much closer to environmental factors, genetic factors, luck, etc. that is, normal risk variation.

        Smoking would probably be a better example, although it shows much more clearly the difficulty of treating such factors as if they were like choosing to forgo insurance.

        And of course you have to show that this form of differential payment and benefit leads to a tragedy of the commons. Which it doesn’t. It’s not the case that people say, “Ooo, statins” and then mainline lard. Giving people better insurance doesn’t induce them to eat worse food. People with higher risk tend to increase overall costs. If we were a younger society, our health care would be cheaper. As we age, our health care costs go up. In both cases, there are subsidies of care.

        The hedge against the risk of illness and injury that health insurance provides is a common resource amongst the policy holders. When one of the common holders of that hedge begins to eat an unhealthy diet, because the insurance provider cannot accurately guage that, the cost is placed upon the healthy dieter.

        No. Until the unhealthy eater gets sick, if they do, there’s no cost. If they do get sick (in a way attributable to their diet), then the cost is shared by the remaining people, healthy eaters or not. If a healthy eating person gets sick, their costs are borne by the remaining healthy pool regardless of diet.

        So, to recap:

        1) The existence of free riders does not entail that there is a free rider problem.

        2) The existence of differential payment and benefit does not entail that there are free riders, and esp. not free riders in a problematic way.

        3) It is easy, an appropriate, to generate notions of “fair share” of costs which doesn’t involve precise proportionality of payment to risk. Indeed, doing so easily lapses into incoherence.

        I hope this round of arrogant, disingenuous twatitude suffices to demonstrate that there is disagreement, at least.

        • Malaclypse

          with a certain BMIs

          For the love of God, please don’t use this example here.

          • Dude, don’t harsh my trolling!

            • BTW, BradP, here I was pretending to be trolling Paul Campous, not you. (BMI is a bit of red flag for Paul, I’m sure you’d agree.)

              • And damnit, I keep putting a “u” in Paul’s name…sorry Paul!

        • bradp

          But even if we grant this, there is still a critical difference between having free riders (or, better put, having subsized participants) and having a free rider problem.

          Agreed, and there is a problem as the contract between insurance company and a person with a poor diet creates an externality on those with good diets.

          Note that on your, shall we say, “model”, sick people are inherently “free riders”. Their risk is 1. Thus, any care over their premium is free riding. Yes this is a reductio of your position, one of many. For example, someone with an unhealthy diet who never consumes any health care in their lifetime. Their risk (we now know) was 0. Yet they paid!

          Not even close. The sick are not free-riders, those who engage in behaviors that are more likely to make them become sick are free riders.

          Now, even if we grant that these people are failing to contribute…what, healthy behavior? to the collective good, it’s still a big stretch to this aspect of their behavior generates a free rider problem. Eating crappily isn’t something that response to the presence or absence of insurance, particularly. Even if you grant your ridiculous and unsubstantiated presumption that we have solid, determinate knowledge of the relation between diet and health risk in any reasonable way (I’m not saying we have no knowledge or there’s no control but any reasonable person would admit that it’s horribly complicated as the margine fiasco shows), it’s just not the case that “healthy eating” is the kind of straightforwardly voluntary behavior with direct benefits and costs to the system that forgoing insurance is. It’s much closer to environmental factors, genetic factors, luck, etc. that is, normal risk variation.

          The externality isn’t that more people are going to take on unhealtier diets, its that more people with healthy diets won’t be able to find appropriately priced health insurance.

          The market won’t become inefficient because too many people eat unhealthy diets, but because too few people have appropriate insurance, necessitating rules to force individuals to accept higher prices for insurance

          1) The existence of free riders does not entail that there is a free rider problem.

          Correct. The existence of an incentive pushing insurance coverage levels below their optimum entails a problem, however.

          • Agreed, and there is a problem as the contract between insurance company and a person with a poor diet creates an externality on those with good diets.

            Let me just grant this. I don’t think it’s so obviously true as I said in response to your posting of that article: It’s not clear how under people’s control their diet, and most especially their weight, is. So, for example, it’d be reasonable to source the externality on, say, food companies. But, let me grant this. Not every externality causes a free-rider problem in the sense we see in the lack of a mandate.

            Not even close. The sick are not free-riders, those who engage in behaviors that are more likely to make them become sick are free riders.

            You don’t get to assert this! You have to at least somewhat argue for it. On your model, paying less than your “fair share” means you free ride. But what makes a share “fair”? That’s a key part of any such model. How we subgroup people is a key aspect of the analysis.

            In any case, it’s clear this has nothing to do with the kind of free rider problem the lack of mandate brings. Vaccination is much much closer.

            The externality isn’t that more people are going to take on unhealtier diets, its that more people with healthy diets won’t be able to find appropriately priced health insurance.

            I don’t have any idea what you’re arguing about here.

            For there to be a tragedy of the commons, we need that each (or sufficient of each) participants benefit from not contributing directly as well as from the common benefit. It also typical that any one free rider has no downside if they remain the only free rider. If I increase my herd by one, the commons is fine! It’s only if everyone makes my move that we have problems. That’s the lack of mandate yet required coverage.

            Here we have a behavior with some subsidized costs (but some internalized costs). That behavior increases the overall costs of the system, but it’s not evident that it does so to the point of destruction in any natural setting.

            Correct. The existence of an incentive pushing insurance coverage levels below their optimum entails a problem, however.

            Perhaps, it really depends. Of course, we have direct incentives to increase people heathy behaviors (as do they). And, this isn’t what is classically called a free rider problem aka a tragedy of the commons.

            • bradp

              Let me just grant this. I don’t think it’s so obviously true as I said in response to your posting of that article: It’s not clear how under people’s control their diet, and most especially their weight, is. So, for example, it’d be reasonable to source the externality on, say, food companies. But, let me grant this. Not every externality causes a free-rider problem in the sense we see in the lack of a mandate.

              I can agree with this. I don’t believe that insurance coverage has much to do with a person’s diet. I don’t believe there is an externality that is causing people to eat a less healthy diet than they otherwise would have.

              Earlier I made a comment about you not finding anything to disagree with. That’s because I felt like you agreed the mechanism that created an externality actually existed. I would like to explore that avenue without constraining ourselves to any particular definition of “free-rider”.

              First off, do you believe that poor diets have the effect of pushing up health insurance premiums?

              Second, do you believe this is a cost-shifting between those with unhealthy diets and those with healthy diets?

              Lastly, much of my argument hinges on treating the hedge, the shared liability, as a common good (a public good, so to speak). How do you feel about that characterization?

              • I don’t believe there is an externality that is causing people to eat a less healthy diet than they otherwise would have.

                Clearly, people each diets other than what’s recommended. (Notice, of course, that recommendations shift, there’s lots of confusing information, and that even for things like heart disease, the connection between diet and heart health isn’t clear, esp. when lots of other factors are taken into account. Smoking is really a much much better example, except, of course, that it’s addictive. But as far as I know, there’s no evidence that stopping smoking or attempting to stop smoking has any downside.)

                That’s because I felt like you agreed the mechanism that created an externality actually existed. I would like to explore that avenue without constraining ourselves to any particular definition of “free-rider”.

                I’m not sure. Can you state what you mean? I certainly agree that, for example, there are different salient risk pools in the general population. I even agree that some of those pools are easily associated with a rather voluntary behavior (wearing seat belts; driving within the speed limit; vaccination). Some are not so easily associated (smoking, eating, exercise).

                In all these, there’s considerable inherent incentives to avoid them: Getting sick sucks.

                First off, do you believe that poor diets have the effect of pushing up health insurance premiums?

                I’d rather pick a less contentious example. But I could grant this.

                Second, do you believe this is a cost-shifting between those with unhealthy diets and those with healthy diets?

                I don’t think so. At least, I’d want to know what makes this different from all the other shared cost aspects of the system.

                In particular, we have to know the ex ante that makes it a shift rather than just an increase in cost. For example, as the population ages, costs go up. Young (healthy) people pay more than the (current) old people did. Is this a “cost shift”? Not as I understand the current term (wherein in a given synchronic slice of the situation we e.g., cut the Medicare reimbursement and the provider makes it up from non Medicare patients; in this scenario, costs weren’t reduced by Medicare, just moved around.)

                I agree that there’s a subsidy and one might want to address the subsidy (e.g., prefunding).

                Lastly, much of my argument hinges on treating the hedge, the shared liability, as a common good (a public good, so to speak). How do you feel about that characterization?

                Not sure. Is it the hedge or the actual care that is the common good? Does that make a difference? My first reaction is that the common good is the care. But maybe that’s off?

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