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.’

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’

Avik Roy At Forbes: ‘How Many Healthy People Are Signing Up For Obamacare? The White House Won’t Say’

Full piece here.

Healthcare.gov is working better now, but the full spin is still on.  Of those new enrollees:

What we need to know is: What is the breakdown of enrollees by age? What percentage have chronic conditions like Type 2 diabetes, high cholesterol, and high blood pressure? This is the kind of data that can help us compare the pool of enrollees in the exchanges to the normal U.S. population.

It’s almost certain that, so far, this enrollment data is not encouraging. Because if it was encouraging, CMS would have released it.’

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’

Some Wednesday Links-Health Care & Foreign Policy

Health Care- From the Federalist ‘How To Opt Out Of Obamacare,’ or things to think about involving your health and legal obligations to purchase health-insurance, despite the mess.  Avik Roy at Forbes discusses the political challenges for Republicans and the likelihood of Obamacare sticking around.  Wonkblog acts as though the Act is fine and gives you a nice online brochure.

Libertarian law/economics thinker Richard Epstein still makes sense to this blog, even if it’s wishful:

‘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.

Are you just waiting to see what happens?

Addition: Who knows what’s happening exactly….anyone….anyone out there?  Ross Douthat:

‘Presumably we should continue to expect the unexpected, and be prepared for developments that don’t just fall somewhere in between “ringing success” and “death spiral,” but surprise us with where exactly they fall, and how their consequences play out.’

Foreign Policy-Walter Russell Mead on Russia, China & Iran (whatever happened to Brazil? addition: that’s economic, along with India that make up the BRICs ).  The End Of History Ends:

‘If the Central Powers continue to work together and to make joint progress across Eurasia, however, either this administration or its successor is going to have to take another look at world politics. For the first time since the Cold War, the United States is going to have to adopt a coherent Eurasian strategy that integrates European, Middle Eastern, South Asian and East Asian policy into a comprehensive design. We shall have to think about “issues” like non-proliferation and democracy promotion in a geopolitical context and we shall have to prioritize the repair and defense of alliances in ways that no post Cold War presidents have done.’

I could be on-board with a more comprehensive Western strategy, perhaps even a return to realism at home with some compromise to be made with our European allies.  This focus on very narrow, possibly poorly-negotiated peace-deals with non-allies and foes is unnerving.  Telegraphing our ‘peaceful’ intentions, and working just towards human rights and Western liberal-Left democracy promotion through a liberal internationalist order can ignore just as many moving parts, if not more, than other schools of thought.

This is risky business.

See this blog’s post and comments on Fukuyama’s new ‘The Origins Of Political Order‘ for some of the Hegelian intellectual foundations on which Fukuyama built The End Of History, and how he defined human freedom and its manifestation in political order.  If you stop to think how influential Marxism has been in one form or another around the globe, and Fukuyama’s response to it, this makes some practical sense even if grand theory isn’t your thing.

Related On This SiteUpdate And Repost- From YouTube: Leo Strauss On The Meno-More On The Fact/Value Distinction?’From Darwinian Conservatism: ‘Nietzsche–Aristocratic Radical or Aristocratic Liberal?’From The Atlantic: Samuel Huntington’s Death And Life’s WorkFrom The American Interest Online: Francis Fukuyama On Samuel HuntingtonFrom Foreign Affairs Via The A & L Daily: ‘Conflict Or Cooperation: Three Visions Revisited’

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

Full piece here.

Let the markets work!

Click through for some spit-balled suggestions, including some kind of mandate upon all individuals to purchase a basic minimum plan (as Martin acknowledges, this is always open to abuse and expansion of power).

‘Whatever solution we look for though, the really important point is this: the whole basis of Obamacare, the notion that we can have more people, getting more benefits, and pay less, is just impossible. The arithmetic doesn’t work. And if you think that’s “unfair,” I’m sorry.

Avik Roy addressed this before the 2012 Romney/Obama presidential election, before we really started taxiing Obamacare down the runway:

‘Obamacare’s approach to pre-existing conditions, in summary, may help a tiny minority with pre-existing conditions to gain coverage in the short term, but the law will drive up the cost of insurance for everyone else, leading to adverse selection and higher premiums for all. And the price of Obamacare is steep: the individual mandate; trillions in new spending and taxes; deep cuts to Medicare providers.’

Epstein’s position:

The best way to deal with the risk of catastrophe is for people to buy their coverage early, when they are young, so that premiums are low. In any well-functioning market, they can acquire a renewable policy with guaranteed rates. At that point, does it become morally reprehensible to deny additional coverage to those individuals who passed on this possibility? No. Sadly, the abysmal performance of the American healthcare system lies not in the market economy that Kristof deplores, but in the elaborate network of regulation that shrinks the domain of voluntary choices, and leaves consumers with fewer choices than they would have had if the government had just stood by.’

Now the government isn’t just standing-by, it’s forcing people out of their current plans onto exchanges that don’t function, exacting high costs on individuals as part of an enormously flawed law in theory, which is being put into practice.

From Charlie Martin: ‘The Arithmetic Absurdity Of Obamacare’

Full piece here.

I’ve gotten a few emails suggesting there’s been a lot of ‘partisanship,’ on the site lately.  I agree there’s more than usual, but in the face of such a pork-passed monstrosity of a law, with so many bad incentives, so much adverse selection, and young people being forced to work in a system that makes so little sense for them, it’s good to have certain ideas boiled down:

Thanks for any concern.  I assume the risk of driving some people away with all this political talk.

Martin:

Now, what’s the point of this little fable? Basically, this is the story of health insurance. We started off with “major medical,” which was a way to protect yourself against big medical bills that everyone hoped they wouldn’t have; now what we’ve got is that major medical — but we’re also paying for snow-shoveling, er, we’re paying for everyone’s day to day medical care, and we’re paying for it in pretty much the most expensive and complicated possible way: through a federal government agencyand insurance companies.

Related On This SiteRichard Epstein At The Hoover Institution: ‘The Obamacare Train Wreck’

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’

Richard Epstein At The Hoover Institution: ‘The Obamacare Train Wreck’

Full piece here.

Click through for analysis on specific provisions of the ACA:

‘Republicans are howling to repeal and defund Obamacare. As a policy matter, that is surely the correct move. But as a political matter, the prompt repeal of Obamacare is just not going to happen over the uncompromising opposition of a Democratic president and a Democratic Senate. So, if the first-best solution is not possible, more modest fixes for Obamacare are in order until Republicans start winning elections’

Epstein looks pretty prescient on what the law’s specific challenges are and how it wasn’t likely to succeed, certainly not by now, but perhaps never in some of its aims:

‘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’

Sounds reasonable to this blog.  There are solutions out there to rising health-care costs.

These aren’t just computer glitches, but rather deep and serious challenges that likely won’t be fixed anytime soon.  I’m reminded of Solyndra, which showed an almost childlike understanding of the private sector and childlike faith in political coalitions guided by rather Left-Of-Center idealism to throw taxpayer money at the industries which were desired to succeed.  Long on speeches, short on delivery.  Lots of politics.

Tech start-ups which actually do succeed (and most don’t) throw a lot of talent and energy balls-to-the-wall to try and solve specific problems to make some process that people engage in now simpler and easier.   These problems can be very complex and challenge the best minds who are under intense deadlines to use their capital well.  There are no guarantees in this high-risk, high-reward activity which can be the work of a lifetime amidst intense competition.  The path is littered with near misses and spectacular failures.

It’s not as easy as it looks.

So, how much politics was involved here?  Avik Roy makes the case a little more starkly:

‘The answer is that Obamacare wasn’t designed to help healthy people with average incomes get health insurance. It was designed to force those people to pay more for coverage, in order to subsidize insurance for people with incomes near the poverty line, and those with chronic or costly medical conditions.’

You won’t just be paying more for your own insurance, you will be forced to buy other people’s insurance, induced into then kept by force in a system of political wrangling where politicians and certain favored interests and coalitions control the money supply much more than they do now.

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 Wednesday Health-Care Links

Richard Epstein still strikes this blog as way too 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.’

That’s a tall order.

Obamacare seems to get many incentives wrong and is based on the idea of cajoling, then forcing, the young into a nationalized system that will severely limit their choices in order to subsidize the old and the bureaucrats/politicians who will have much greater power over their lives.  Every law has winners and losers, and any change will be uncomfortable, but the goal for many was to ram through a one-size-fits-all, top-down law and worry about the details later.   I imagine a core of the bill’s supporters would be quite comfortable with socialized medicine and were quite ok with empty campaign promises about lowering costs as long as this thing passed.

It’s just pretty bad law.

Avik Roy wants some form of guaranteed issue to address costs but wants to steer us towards free-market solutions, rather than the current direction.

Robert Book at Forbes adds:

‘If it’s discriminatory to assume that every potential voter has access to a government photo ID — which is free — how is it not discriminatory to assume that every American has a computer with internet access, to obtain health coverage on healthcare.gov?’

I really thought Americans, even the young, the hip, and racially conscious had enough independence of spirit and skepticism to gently mock the progressive Food Pyramid bureaucrats.  You really don’t need many of these people claiming to know better than you how to run a major portion of the economy and increasingly telling you how to run important parts of your life, like where and how much you end up working and what kinds of food you ‘ought’ to be eating.

It’s like chaining yourself to a series of pneumatic tubes in an act of collectivist solidarity.

I understand that not everyone shares my view.

Thanks to a reader.  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’

Avik Roy At Forbes: ‘Unpublished CRS Memo: Obama Administration Has Missed Half Of Obamacare’s Legally Imposed Implementation Deadlines’

Full piece here.

Oh, but it’s still coming, fellow citizens:

‘Obamacare may fail at reducing insurance premiums, or at wisely using taxpayer funds. But the law is scheduled to spend $1.9 trillion over the next ten years. At that, it is unlikely to fail.

A significant amount of that money may not go to the people for whom it’s intended. It may not have the benefits on health outcomes that the law’s most zealous supporters insist it will. But barring substantial Congressional action, that $1.9 trillion will still get spent, along with trillions more thereafter. Only new laws, not wishful thinking, will change that.’

The White House’s Site.  Remember, they have to pitch, cajole, entice and market this to young people at this delicate stage.  The money, sweat and compliance of the young will make it run.

I’ll still take Chicago school law/economics thinker Richard Epstein’s suggestion:

‘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.’

That’s a start.

This newly forged relationship between you and your government will be the doorway to all sorts of new intrusions, like what and how much you eat, how much exercise you get, where you spend your money and who has the moral authority to be in charge of you.

The nationalization and socialization of health-care has been one of the primary goals all along.

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’

Covering the law and economics from a libertarian perspective: Richard Epstein At The Hoover Institution Journal: ‘Three Cheers for Income Inequality’Richard Epstein At The Hoover Institution: ‘Death By Wealth Tax’Richard Epstein At The Hoover Institution: ‘The Obamacare Quaqmire’

Phillip A. Klein At The Washington Examiner: ‘Obamacare’s Employer Mandate To Be Delayed A Year’

Full post here.

What could it mean, other than employers are giving the administration heat about being pressured by the deadlines?

‘Politically, the decision smacks of the Obama administration wanting to defer the impact of the law on businesses during the 2014 midterm election year, avoiding headlines about businesses cutting staff levels or reducing worker hours to get around the mandate. But it could also be politically dangerous, by reinforcing the idea that the law is a looming train wreck.’

Avik Roy at Forbes, who’s been following the ACA closely:

‘In the short term, the delay will have several effects. First, the mandate drives up the cost of labor, and therefore increases unemployment; delaying the mandate by one year may modestly mitigate that disincentive.

Most importantly, the delay of the mandate means that more people will want to enroll in Obamacare’s subsidized insurance exchanges. Every year, fewer and fewer employers offer health coverage; given one more year to restructure their workforces, this process could accelerate’

Some people are working quite hard so that the government can unite us all in equal misery it seems.

Reihan Salam has more here.

Related On This Site:  Avik Roy At Forbes: ‘Democrats’ New Argument: It’s A Good Thing That Obamacare Doubles Individual Health Insurance Premiums’

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’