Saturday, July 22, 2017

Think-tank experts need to keep first principles in mind when they offer prescriptions for issues

I think a paragraph from my "Further Explorations" post this morning needs some additional fleshing-out.

A guy like Schlichter is just as culpable as any pussy-hat marcher for the death of Western civilization. The whole where-have-the-position-papers-from-the-think-tank-pointy-heads-gotten-us mentality is nothing short of Jacobin.
This is particularly so, since, along with Kurt Schlichter, someone else has been on my mind lately for his damage to actual conservatism. The kind of damage and the reason for inflicting it are different, but it's damage nonetheless.

I'm speaking of the American Enterprise Institute's James C. Capretta. Here's what I wrote about him in a recent post:

Economic viewpoints? They range from Elizabeth Warren-style redistributionism to libertarian clamorings for a pure free market. In between are odd phenomena such as the insistence of the American Enterprise Institute's James Capretta that any alternative to the "A"CA include strong tax-policy incentives for people to not let their insurance coverage lapse, a heavy-handed, government-based stance for an ostensible champion of economic liberty to take. It's the government-has-to-do-something mentality that has led to Congressional paralysis over the "A"CA's repeal.
Neo-neocon wrote about him today, remarking on Capretta's latest piece, "The GOP's Collision With Health Care Reality." The relevant part here is when she discusses . . .

 . . . Capretta’s final suggestion for the GOP, a piece of advice that seems even more divorced from reality than the GOP’s actual behavior:

To get a better result with a renewed push, the GOP should include willing Democratic senators in the conversation. The party should understand that the goal should be a plan that costs less, reduces regulations, and injects serious market discipline into the system, even while ensuring all Americans have ready access to insurance. That may mean finding a compromise approach on giving individuals strong incentives to enroll in health insurance. The party should also work with GOP governors to find a reasonable and affordable compromise on Medicaid, one that provides for significant reform of the program, with more state control and clear federal budgetary restraints, while also providing a safety net to all Americans with incomes below the poverty line.
It would have been easier, and more fruitful, to pursue a bipartisan deal of this kind in the weeks after the election. That was when Republicans had the most power. But they still have some leverage. They should use it when the time is right to begin the process of moving health policy in a direction more to their liking. That will inevitably be less satisfying to some than writing a bill entirely on their own because of the compromises that will be necessary, but this kind of legislation would be far more likely to pass, and also survive when political control inevitably changes again. 
The sole exception to the disconnect from reality expressed there is one sentence that makes sense to me: “The party should also work with GOP governors to find a reasonable and affordable compromise on Medicaid…”. Other than that, I’m not sure what world Capretta is living in, but it’s not the one I’ve been observing for well over a decade. I don’t see any possibility of compromise on the part of the Democrats, who threw down the partisan gauntlet when they passed Obamacare in the first place. On Obamacare, the only compromise they will accept is complete capitulation from the GOP. 
You may be seeing why I bring this up in a post that starts out lambasting a Trump water-carrier for pooh-poohing think tank scholars.

My point here is that a guy like Capretta makes it sticky for a guy like me to defend think-tank scholars. His view of the health-care situation is so mired in wonkery that he can no longer see what his premise ought to be (individual liberty). Indeed, he is so ate up that, as Neo points out, he actually thinks reaching across the aisle to the anti-freedom folks would have some point to it.

Fortunately, we have the likes of the Cato Institute's Michael Tanner to counteract such pointy-headedness:

1. Health care is neither a right nor a privilege; it’s a commodity. Worse, it’s a finite commodity. There are only so many doctors, so many hospitals, and so much money, and there are limits to how much these things can be expanded. That’s why no health-care system, outside Bernie Sanders’s fantasies, provides unlimited care to everyone.

Every health-care system in the world rations care in some way, either through bureaucratic fiat (Scandinavia, the U.K.), waiting lists (Canada), or price (that’s us). One can argue about which of these rationing mechanisms is fairest or most efficient, but let’s not pretend that it won’t occur.
 2. Coverage is not access. Democrats like to pretend that giving everyone a piece of paper called insurance guarantees them access to the care they need. It’s sort of like magic. Say the right words, and poof, medical care appears. But in the real world it doesn’t work that way.

For example, take Medicaid, which is responsible for more than half the increase in coverage under Obamacare. Nearly a third of primary-care physicians won’t accept Medicaid patients.
3. The uninsurable are uninsurable. Let us remember that the definition of “pre-existing condition” is: someone who is already sick. It’s a little like driving your car into a tree and then trying to retroactively buy auto insurance. It won’t work. Insurance is the business of spreading risk. But for someone who, say, has cancer, there’s no risk to spread, just cost. That’s not insurance, it’s paying for health care.

Obamacare tried to square this circle by mandating that young and healthy people buy insurance to offset the cost of providing care to those already sick. It turns out that didn’t work. Not enough healthy people signed up to pay for the influx of sick people. Insurance companies either dropped out of the market, cut back on high-quality providers, or raised premiums. All of this forced more healthy people out of the insurance pool and threatened an adverse-selection death spiral.
4. Medicare is not a success. Faced with the wreckage of Obamacare, Democrats are increasingly embracing the once controversial idea of “Medicare for all.” Most of them would start slowly, with a Trojan-horse “public option,” a taxpayer-subsidized plan that would undercut private insurance, but the result would still be a government-run national health-care plan based on Medicare. 
We need to arrange a beer summit for Capretta and Tanner so the latter can school the former - and thereby put a cork in the pie holes of "populism" fans.


17 comments:

  1. Back before we were largely liberated from employer-based health insurance plans there truly was a risk pool where the healthy subsidized the unhealthy, yep, younger workers were by nature healthier. It's so great to now be free at last, free to gamble with our finances and not participate in health insurance. It is called negative selection. And where do these citizens go if something unforeseen arises with their health? Uh, I think it's called Medicaid. Back to the true risk pool where all the taxpayers foot the bill. But, by God in His Heaven above, we're still strivin' to be free. By the way, gotta love the way it all turned out, from half a dozen years of disputation where the rallying cry was repeal and replace, to merely just repeal. Lying sacks of dung!

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  2. "All taxpayers foot[ing] the bill" is exactly what must never happen. To repeat a maxim that is core to the LITD worldview, it is morally wrong for government to use its monopoly on the legitimate use of force to take Citizen A's money to pay for the particular situation of Citizen B.

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  3. What is Medicaid if not all taxpayers footing the bill?

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  4. Indeed, that's what it is and that's why it's bad.

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  5. Hey Michael Mitchell, help him out here.

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  6. If you're going to provide an anecdotal example of someone who has come to rely on Medicaid, it doesn't prove the unsoundness of the program or the wrongness of wealth redistribution.

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  7. So what do we do with the uninsurable?

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  8. Title XIX amendment to Social Security Act (1965) is the enabling statute.

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  9. I'd suggest that there's not a "we" that should do anything about them. There are a number of good ideas out there, most taking some form of the basic high-risk pool model.

    Re: the enabling statute: Um, okay, whatever that has to do with anything.

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  10. The basic high risk pool is basically crony capitalism. And, sure, previously enacted legislation has nothing to do with it. Tell that to the judge.

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  11. Nothing at all. Something becoming law tells us nothing about whether it's good or bad.

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  12. Nope, only if it is constitutional and it was. The good part is it was democratically enacted in the most exceptional nation on earth, especially back then. Deal with it.

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  13. Still doesn't tell us anything about whether it is good or bad.

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  14. Sort of like marijuana laws. States and the federal government have a bunch of them on the books, but some citizens think they're really bad.

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  15. Yep and some citizens worked within the system to repeal their states' laws. Have at em Jeffie, to you considerable peril.

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  16. Stay on topic, if you would. I know that the mere mention of marijuana gets you all excited, but what we're talking about here is whether a law being passed about something tells us anything about whether the matter in question is good or bad.

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