Bobo engages in his trademark style of argument, focusing on abstractions and ignoring evidence about whether or not markets actually work for a given problem. Cohn does a good job pointing out the problems, and I think the most important one is near the end — the comparison with other countries. Brooks asserts that “there is no dispositive empirical proof about which method is best.” But the policies of virtually every other country in the world give us the chance to compare a relatively “free market” in health care to more state-oriented approaches, and the evidence is unambiguous. The “free market” delivers coverage to many fewer people for more money, and usually far more money. Although Brooks likes portraying debates between an imaginary ‘Burke” and “Rousseau” while casting himself in the former position, in this case it’s Brooks who’s ignoring all the empirical evidence to cling to his abstract beliefs about the benefits of markets. And he does this despite the fact that — between the inelasticity of demand, lack of informed consumers, and strong incentives insurers have to deny coverage to vulnerable groups — there’s no good reason to expect health care markets to work even in theory.
Tag: "health care"
Joe Nocera’s pleas to accept the Ryan plan as a conversation-starter notwithstanding, there’s no conversation less in need of starting than the conversation about how to reduce Social Security and Medicare benefits. It’s hard to think of another topic Beltway pundits are more likely to talk about. Nor can you contribute to the conversation with a worthless plan.
Let’s also be clear who started this. It is true that there’s an enormous amount of waste in the American system, and the example of virtually every other liberal democracy indicates that we could cover more people for less money by reducing or eliminating the role of private insurers. But, of course, even the cost reductions in the ACA — which were modest because of the need to buy off stakeholders created by the Madisonian system — were deemed by the GOP in 2010 as getting the government into your Medicare. The “leave Ryan alooooone!” argument is a plea for unilateral disarmament…against people who are ideologically opposed to the New Deal/Great Society social contract and aren’t honest. I’ll pass, thanks.
Watching Paul Ryan earlier today talking at the Peterson Fiscal Summit I was amazed by the number of times he said the word “Mediscare,” which is a conservative jargon term for telling the truth about proposals to eliminate Medicare.
Mr. Ryan may claim — and he may even believe — that he’s facing a backlash because his opponents are lying about his proposals. But the reality is that the Ryan plan is turning into a political disaster for Republicans, not because the plan’s critics are lying about it, but because they’re describing it accurately.
Take, for example, the statement that the Ryan plan would end Medicare as we know it. This may have Republicans screaming “Mediscare!” but it’s the absolute truth: The plan would replace our current system, in which the government pays major health costs, with a voucher system, in which seniors would, in effect, be handed a coupon and told to go find private coverage.
The new program might still be called Medicare — hey, we could replace government coverage of major expenses with an allowance of two free aspirins a day, and still call it “Medicare” — but it wouldn’t be the same program. And if the cost estimates of the Congressional Budget Office are at all right, the inadequate size of the vouchers — which by 2030 would cover only about a third of seniors’ health costs — would leave many if not most older Americans unable to afford essential care.
I’m also amused that Karl Rove has decided to advocate the same political strategery as Col. Mustard. Trying to find the “right messaging” for a plan to destroy Medicare to fund massive upper-class tax cuts is like trying to find the right metrics to show that Melky Cabrera is the greatest player in baseball.
I think this is an important point: arguments that various Democratic proposals on health care were once “Republican proposals” are misleading, in the sense that it’s not as if Republicans enacted them when they controlled government or anything. It’s misleading to imply that the Republicans favored even modest health care reform in any meaningful way.
Group A: People who argue that the individual mandate in the ACA is unconstitutional because it must be unconstitutional to force people to “purchase a private product” irrespective of its effect on interstate commerce.
Group B: People who strongly support gutting Social Security and replacing to with a system where people are forced to purchase products from private money managers.
The Overlap Group: People whose opinions about the constitutionality of the ACA should be greeted with some mixture of laughter and contempt.
Estimated Extent of Overlap: >95%
Atrios is optimistic*:
Federal judge strikes down whole law, sez mandate is unconstitutional and cannot be severed from rest of law.
Maybe we’ll return to my crazy idea to pay for it out of taxes.
The problem is, though, that if the entire bill is struck down Humpty Dumpty isn’t going to be reassembled (let alone in a more pleasing form) for the foreseeable future. First, it’s likely to be be quite a while before we have 60th vote in the Senate as liberal as it was in early 2010 to go with a substantial Democratic House majority and a Democratic president. And, second, the new legislative coalition would have to be more liberal, as the most obvious way of buying off the vested interests without direct tax hikes is no longer available. So the Supreme Court striking down the ACA in its entirety would be very bad — as I suspect Duncan would agree, a decade or three more of the status quo in exchange for a slightly more rational bill isn’t a good tradeoff.
If the mandate is eliminated without severance, though, that’s a different story. As long as the pre-existing conditions ban remains in place (and it would be nearly impossible politically to get rid of it), vested interests would be intensely interested in finding a fix for the mandate, so you wouldn’t need a similarly liberal legislative coalition. I’d buy a conservatives-should-be-careful-what-they-wish-for in that case, but not if the whole ACA is struck down.
*UPDATE: Atrios is not, in fact, optimistic.
I have some thoughts inspired by Jon Cohn’s article about constitutional challenges to the ACA. The short version is that I doubt that even a scenario where the Supreme Court strikes down the mandate — which I still regard as relatively unlikely — would have the far-reaching consequences that libertarian heroes hope. The reason for this is that a radically reduced federal government is a position that has no real political constituency, and the Supreme Court rarely intervenes in such circumstances. Although there’s still a widespread belief that the Supreme Court is “countermajoritarian,” it tends to reflect the values of political elites. (To borrow Mark Graber’s line, a generation of constitutional scholars discussed the Warren Court as if Barry Goldwater won a huge landslide in 1964.) If pro-Hammer v. Dagenhart sentiments become more than a fringe phenomenon, the Supreme Court might join in. In a political context where even tea party congressmen aren’t willing to name a single federal program they’d favor cutting, there’s not going to be any “federalism revolution” or return to the laissez-faire constitutionalism of the Gilded Age.
In a way, the instructive anecdote Cohn starts with also illustrates the point:
A few weeks ago, I spoke with Hyder at his office, in order to learn more about why he had brought this case. He said his motive was straightforward. He’s opted not to carry health insurance because he doesn’t think the benefits justify the price, and he doesn’t want the government forcing him to do otherwise. Okay, I asked, but what if he gets sick and needs hospitalization? How will he afford those bills? It was a distinct possibility, he agreed, patting his waist and noting that he was a little overweight. But those potential bills would be problems for him and his hospital, he suggested, not society as a whole.
When I told him that I disagreed—that his decision to forgo health insurance meant other people would be paying his bills, via higher taxes and insurance premiums—he politely and respectfully took issue with my analysis. The discussion went back and forth for a while, but soon it became apparent that our differences went beyond the finer points of health care policy, to our most basic understanding of the rights and obligations of citizenship. “It’s a complete intrusion into my business and into my private life,” he told me. “I think it’s one big step towards a socialist society and I’m purely capitalist. I believe in supply-side economics and freedom.”
The guy talks like a libertarian, but note that the punchline isn’t “if I need emergency care, the hospital should refuse to treat me if I can’t pay cash,” it’s “the hospital should treat me and indirectly stick someone else with the bill if I can’t pay.” Tells you what you need to know.
A bill to repeal the health care law drew the full force of both parties Tuesday as debate on the measure opened in the House, launching a two-year battle over President Barack Obama’s signature domestic achievement.
Ahead of the vote Wednesday, House Republican leaders pressed a new line of attack, accusing Democrats of thwarting the will of the people by not committing to give the bill an up-or-down vote in the Senate.
…UPDATE [SL]: Some useful data to put this highly principled Republican claim in context.