Megan McArdle At Bloomberg: ‘A Few More Arguments Against Obamacare’

Full piece here.

A thoughtful piece:

‘This is not a tedious rehash of my reasons for opposing Obamacare, though two years in, perhaps such a rehash is due. If it is, I will provide it in a different post. This is just a post on why I don’t think that the argument for Obamacare can rest very securely on the argument that we are simply cleaning up some ugly negative externalities, in much the same way that we do with noise ordinance and anti-pollution laws. That is not what we are doing, and if it were, we wouldn’t be doing it’

You don’t have to be libertarian to find some of Richard Epstein’s suggestions…reasonable:

As I have noted before, there is only one type of reform that can make progress in meeting the three goals of a sensible health care system: cost reduction, quality improvements, and public access. That reform requires massive deregulation of the many market impediments that are already in place. Lower the costs, drop the excessive mandates, and thin out administrative costs, and people will flock back to the system voluntarily.’

Related On This SiteFrom The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

Single-Payer And Pies-In-The-Sky

Vermont can’t keep moving towards single-payer, as even the folks in charge of Vermont have determined it’s not economically feasible.

The ACA isn’t single-payer, of course, but I’m guessing much support for Obamacare comes from similar pools of sentiment:  Those sympathetic to activist models of governance and the progressive coalitions held together for a time by this President, as well as those who stand to gain the most from the law: Some lawmakers, like-minds in California’s health-care system, many health-care bureaucrats with dogs in the hunt, direct recipients and the few ‘winning’ companies and contractors who will receive the money, prestige, and political power required to implement the law.

Megan McArdle foresaw the likely outcome Vermont back in April:

‘So this is going to be expensive. So expensive that I doubt Vermont is actually going to go forward with it.

This should be instructive for those who hope — or fear — that Obamacare has all been an elaborate preliminary to a nationwide single-payer system. It isn’t. The politics are impossible, and even if they weren’t, the financing would be unthinkable.’

From another piece of hers:

‘The problem is that Obamacare promised too much:  universal coverage, and no rationing, and lower costs.’

The problem as this blog sees it, is that you can end-up harming everyone more than helping in the long-run; over-promising and under-delivering ultimately to those you’re claiming to help and through taking away a lot of liberty, wealth and public trust in the process.

The moral case has never been sufficiently made to me that health care is a right.  Of course, there were serious cost problems with the jerry-rigged system we had going (where our health-care delivery system was used to dispense care inefficiently to save lives), but the solution we’ve legislated will now require much more government oversight of a limited resource, potentially increased politicization of the issues at stake, and the likely growth of a vast bureaucracy with its own inefficiencies, self-interested politics and inertia.  It’s as if we’ve backed into a forest of potentially unnecessary hazards without necessarily having the potential rewards to show for it.

Related On This Site:  Avik Roy At Forbes: ‘Democrats’ New Argument: It’s A Good Thing That Obamacare Doubles Individual Health Insurance Premiums’Megan McArdle At Bloomberg: ‘Health-Care Costs Are Driven By Technology, Not Presidents’

Richard Epstein At The Hoover Institution: ‘The Obamacare Quaqmire’

Richard Epstein At The Hoover Institution: ‘Watching Obamacare Unravel’

From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’

A Few Friday Gruber Links-The First 2,000 Names In The Boston Phonebook

Paul Gregory at Forbes On Gruber

‘Professor Gruber must use “behavioral assumptions” to guesstimate, among thousands of other things, how many young people will ignore the mandate, how many employers will drop coverage, and how providers will react to new incentives and compensation schemes.

Do not worry, says the Times.  Gruber’s behavioral assumptions are “based on past experience and economic theory.” But where is “past experience” when we entirely revamp our health-care system? Economic theory, at best, may give us the first-order directions of change, but it is helpless to account for the all-important higher-order effects and feedbacks. We economists hold the secret of how little we really know close to our vests.’

Claiming the mantle of science provides moral justification enough for some supporters of this huge central planning project, with everyone’s time and money.

A bigger concern may be how badly the law is written, and barely cobbled together, because after all, genuine health care reform wouldn’t hurt.

More here and here.

Related On This SiteFrom The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

Some Friday Links-Your Data Has Been Massaged & Foreign Affairs

The Hoover Institution looks at the late Fouad Ajami’s book of essays:

‘Writing on Iraq, he suggests that many troubles in the Arab world can be linked to America’s limited understanding of the region, thirst for oil, and need to deal with terrorism. He provides a chilling look at the life of 9/11 hijacker Ziad Jarrah, asserting that “the very normalcy of his upbringing and the old hedonism giving way to a sudden need for absolution are much more unsettling than the warning signs and the zeal of a true believer.”

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Megan McArdle At Bloomberg, Obamacare inflates its numbers. I feel sick:

When reality doesn’t line up with political promises, massaging the data to the point of absurdity becomes necessary.

‘The administration counted stand-alone dental plans in order to claim that 7.3 million people had signed up during the first open enrollment period. Without the addition of the dental plans, enrollment would have very slightly missed its target of 7 million enrollees. Moreover, simple arithmetic indicates that it is still counting them in its current claims about enrollment.’

Perhaps even some big data folks and (S)cience driven realists are realizing that when it comes to ideology and politics, technocracy and bureaucracy, the pursuit of truth is often left to bad masters.

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Andrew Michta At The American Interest: ‘Putin Targets The Scandinavians:’

Not a Cold War, really, but let’s have some strategy:

If you’re in Lithuania, Latvia, and Estonia, you’re looking at Georgia, Ukraine and you’re own Russian populations, Putin’s actions and you’ve probably been thinking a lot lately.

‘As 2015 approaches, NATO finds itself confronted with the urgent need to address the fundamentals of deterrence and collective defense in general, and to go beyond the important symbols of “persistent rotations.”

Megan McArdle At Bloomberg: ‘Simple Policies Win Elections’

Ron Fournier at the National Journal: ‘Obamacare’s Foundation Of Lies

On the Gruber gaffes (forcing healthy people to work against their interests with knowing lies withheld by a chief Obamacare architect in order to get the thing passed):

‘A lie is apolitical, or at least it should be. If there is one thing that unites clear-headed Americans, it’s a belief that our leaders must be transparent and honest.

And yet, there seem to be two types of lies in our political discourse: Those that hurt “my party” and “my policies”; and those that don’t. We condemn the former and forgive the latter—cheapening the bond of trust that enables a society to progress.’

Megan McArdle has a piece here.

Aside from the Gruber gaffes:

‘So too, with Obamacare.  They wanted a massive overhaul of the whole system, but they couldn’t do that cleanly, so they jammed a bunch of complicated mechanisms into one sort-of-working bill.  You may like the goal of Obamacare, or you may not. Either way, you probably wouldn’t choose this particular method of implementation, which is simultaneously less comprehensive, more expensive and more annoying than many other methods they could have chosen.’

You don’t have to be libertarian to find some of Richard Epstein’s suggestions…reasonable:

As I have noted before, there is only one type of reform that can make progress in meeting the three goals of a sensible health care system: cost reduction, quality improvements, and public access. That reform requires massive deregulation of the many market impediments that are already in place. Lower the costs, drop the excessive mandates, and thin out administrative costs, and people will flock back to the system voluntarily.’

I still see a massive, top-down, poorly conceived law that freezes a lot of the problems in place, adds more layers of bureaucracy on top, and serves a narrower range of interests that claim universal, utopian ideals.

Follow the money.

In the meantime, the rising costs, bloated bureaucracy, misplaced incentives etc. of the current system continue.

First, do no harm.

Related On This SiteFrom The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

Obamacare, The Islamic State & Vietnam-Three Friday Links

Avik Roy is working towards Obamacare alternatives, but has always supported some form of universal coverage, about which this blog harbors doubts. Perhaps much in the same way that human rights and human rights institutions have become part of the foreign policy institutional landscape, so too could universal coverage become part of the furniture.  Big, heavy furniture.

A healthy skepticism might recognize that such a delivery system could likely create too tantalizing a prize for Leftward ideological interests and perhaps too immovable an institutional object to remain nimble and responsive to We The People over time.

Nevertheless, Roy is really working on rising health-care cost problems, and it addresses many of the flawed incentives and ridiculous complexity and overreach of the ACA:

‘One of the fundamental flaws in the conservative approach to health care policy is that few—if any—Republican leaders have articulated a vision of what a market-oriented health care system would look like. Hence, Republican proposals on health reform have often been tactical and political—in opposition to whatever Democrats were pitching—instead of strategic and serious.

Those days must come to an end. The problems with our health care system are too great. Health care is too expensive for the government, and too expensive for average Americans.’

Bing West at The National Review on the Islamic State, and possible options:

‘As war author Karl Marlantes has written, don’t treat a human life as a bargaining chip, unless you are willing to be that chip. Too many policymakers and generals think of violence, if they think of it at all, as a negotiating tool.’

If we go in with guns blazing, aren’t we aligning ourselves with Iran and their proxy war in Iraq and Syria and goals for nuclear domination?  I mean, as far as nuclear negotiations, we’re already out on a limb with an increasingly desperate American President and a repressive authoritarian regime in which the Ayatollah has final say over a very real divide between Iranian and American interests.

Perhaps we have interests to let both sides fight it out. This could weaken both Tehran and IS.  We could help arm the Kurds and see if the branches of the Peshmerga are up to the task of battling IS, try and have Maliki’s departure not devolve into a bloody mess, keep channels open with the Turks, Jordan, Lebanon and…develop something vaguely representing leadership and protection and advancement of our interests and alliances.

Lead!

But how aggressively?

Meanwhile, given the extreme lunacy and violence of IS against the Yazidis, Iraqi Christians, and others in their path, and the clear security threat they post to Western interests, even the humanitarian interventionists and the American public are beginning to see the tatters of current foreign policy and the fires raging throughout the Middle-East.

On that note, it’s nice to relax and read about another part of the world, even if it has an old Communist structure in place.  Michael Totten visited Vietnam:

‘Some parts of Hanoi are a bit messy, but aside from the outdated rat’s nest of electrical wires, its messes are the kind you make in your house when you’re in the middle of a remodeling project. Parts of the Old Quarter still look a little decayed, but even there the decay is like a holdover from the past that’s being blotted out with one high-end boutique store after another.’

From The Top-Down-Two Saturday Obamacare Links

Walter Russell Mead points to some concierge innovation going on in Texas (doctors forgoing insurance for fee-based service) that Obamacare proponents will not like:

‘This bias against innovators is what happens when federal legislation cements a dysfunctional system in place. Doctors who want to experiment with new models of payment face social pressure to abandon these experiments because of policy choices made in Washington.’

It remains unclear how freezing an inefficient health-care delivery system by adding a complex bureaucracy atop filled with many new ideological and monied interests all overseen from one place is going to….

Megan McArdle notes that in Vermont:

‘…Act 48 required Vermont to create a single-payer system by 2017, the state hasn’t drafted a bill spelling out how to raise the additional $1.6 billion a year (based on the state’s estimate) the system needs. The state collected only $2.7 billion in tax revenue in fiscal year 2012, so that’s a vexingly large sum to scrape together.’

I recommend “Collectivist’s Deficit Crunch” and/or “Hippity-Dippity Top-Down Technocratic Caramel Groove” for new Ben & Jerry’s ice-cream flavors.

You don’t have to be libertarian to find some of Richard Epstein’s suggestions…reasonable:

As I have noted before, there is only one type of reform that can make progress in meeting the three goals of a sensible health care system: cost reduction, quality improvements, and public access. That reform requires massive deregulation of the many market impediments that are already in place. Lower the costs, drop the excessive mandates, and thin out administrative costs, and people will flock back to the system voluntarily.’

What E.J. Dionne Neglects To Understand-Todd Zywicki At Volokh: ‘Dionne v. Hayek’

Full post here.

In response to an op-ed by E.J. Dionne:

‘So the problem is not the welfare state, it is the central planning.

Obamacare provides the illustration of this, as I think many people have intuited. The “economic problem,” of course, is inescapable in health care. The supply of health care is scarce (only so many resources can be dedicated to it relative to other ends in society) and the demand is pretty close to unlimited. Somehow or other we have to decide how to allocate these scarce means among all the different ends–preventive medicine, end-of-life care, primary research, specialists v. generalists, etc.’

And under the ACA, we’ve opted to involve politicians and their short-term goals (getting re-elected) much more than before in making these decisions, which I understand to be a net loss.  If folks at the AMA or independent panels think they’ll be operating free of such public-choice and political pressures, they might want to think again.

Here’s Pournelle’s Iron Law of Bureaucracy:

‘Pournelle’s Iron Law of Bureaucracy states that in any bureaucratic organization there will be two kinds of people”:

 First, there will be those who are devoted to the goals of the organization. Examples are dedicated classroom teachers in an educational bureaucracy, many of the engineers and launch technicians and scientists at NASA, even some agricultural scientists and advisors in the former Soviet Union collective farming administration.

Secondly, there will be those dedicated to the organization itself. Examples are many of the administrators in the education system, many professors of education, many teachers union officials, much of the NASA headquarters staff, etc.

The Iron Law states that in every case the second group will gain and keep control of the organization. It will write the rules, and control promotions within the organization’

The fact is, with Obama’s political coalitions we already see union-interests, rent-seeking volunteers and activists influencing our politics.  Such is politics, in fact.  I don’t necessarily begrudge these folks their idealism and desire for change, but I do begrudge the means by which they are pursuing that change and the consequences of their idealism.

The less there is or there is perceived to be, the more people tend to fight over it, which suits some people accustomed to seeking their interests through political activism just fine (there will be winners and losers here), but we’ve arguably chosen a very poor way indeed to meet the moral aim of inclusion through health-care access, overall economic growth and thus more racial and pluralistic tolerance, as well as equality under the law (our politics seems even more contentious than ever).

As if the partisan divide, the rollout of Obamacare, the unmet political promises and the sheer complexity of the law wasn’t enough to make you doubt already…

Related On This SiteFrom The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

Classical Liberalism Via Friesian.Com-’Exchange with Tomaz Castello Branco on John Gray’

From The Volokh Conspiracy: ‘From “Liberaltarianism” to Libertarian Centrism?’

Liberaltarianism?:  Will Wilkinson And Jonah Goldberg On Bloggingheads: Updating Libertarianism?From Reason’s Hit And Run: What Kind Of Libertarian Are You?

A Few Thursday Obamacare Links

Megan McArdle At Bloomberg. ‘Latest Obamacare Delay Is Probably Illegal

‘Ultimately, if Obamacare is going to hang together and not break down into an expensive mess, the administration is going to have to force some people to take unpleasant medicine. Until it demonstrates that it is willing to do so, the law and the insurance market remain at risk.’

I think many Americans see a role for the government to play in regulating competitive marketplaces and all the shenanigans found therein.  The ACA goes many steps beyond this, however, to an enormous, centrally-planned bureaucracy, freezing much of the current health-care delivery dysfunction in place and controlling these markets from above.  To many still supporting this law in principle if not in practice, there is knowledge enough, technology enough, and political leadership enough to make this happen and thus meet their moral and ideological commitments.

It’s the right thing to do.

So, is there necessarily knowledge, technology or political leadership enough to meet the demands this law places upon all of our heads?

Ed Morrisey at the Fiscal Times:

‘Hayek took von Mises’ argument a step further. Not only would such command economies fail, Hayek argued, but they would produce increasingly arbitrary governance and eventually erode the rule of law altogether. “[T]he use of the government’s coercive powers will no longer be limited and determined by pre-established rules,” he predicted. “The law can, and to make a central direction of economic activity possible must, legalize what to all intents and purposes remains arbitrary action.”

In order to make the law what you want it to be, you may have to selectively enforce the law in the meantime.  That’s not exactly a good definition of fairness, justice, nor equality under the law.

Richard Epstein still has some good ideas:

‘As I have noted before, there is only one type of reform that can make progress in meeting the three goals of a sensible health care system: cost reduction, quality improvements, and public access. That reform requires massive deregulation of the many market impediments that are already in place. Lower the costs, drop the excessive mandates, and thin out administrative costs, and people will flock back to the system voluntarily.’

Related On This SiteFrom The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

Two Wednesday Obamacare Links

Reasonable people can agree that health-care and education are among the most vital interests in our society, and to individuals within it. But reasonable people can also agree that some folks seeking to control health-care and education are guided by unsustainable ideals.  They bring with them political coalitions and interests that often end-up free-riding on the public good, and make promises to individuals which can’t be kept.  They often succeed by directing as much public money as possible towards their own coalitions while keeping political power close, punishing political enemies, and bending as much public sentiment as possible toward their ideals.

We now have an enormous, hastily-passed, partisan bill seeking to further entrench many of the unsustainable portions of our health-delivery system, while adding many layers of interests, bureaucrats, and politics atop that.

At what price inclusion of some previous groups and peoples into the ‘greatness’ vision of America and its institutions?

Yes, it’s an anecdote-Walter Russell Mead: ‘I’m Calling It Kafkacare: One Reader’s Obamacare Experience

‘Short version: We met with our broker the second week in October. It’s nearly February. We still don’t have our coverage figured out. From now on, I’m calling it Kafkacare.’

Mead publishes a pro-Obamacare reader response.

You’ve got to get the incentives right. From The Apothecary: ‘Surprise, Massachusetts is Home To America’s Worst Performing Obamacare Exchange:’

‘Connector staff members have admitted privately that the generous flow of federal dollars was the primary motivation to rebuild the entire website. The federal government was requiring additional functionality of the site under the ACA, but it is unclear if the Connector could have saved taxpayers millions by simply building off the foundation they already had in place.’

Politically and ideologically, money and career-wise. some folks will keep pushing until it sticks.

Still Looking For Alternatives-Charlie Martin At PJ Media: ‘Obamacare vs. Arithmetic’

Avik Roy At Forbes: ‘Democrats’ New Argument: It’s A Good Thing That Obamacare Doubles Individual Health Insurance Premiums’Megan McArdle At Bloomberg: ‘Health-Care Costs Are Driven By Technology, Not Presidents’