Two Wednesday Links-Roger Scruton & Megan McArdle

March 14, 2017 / chr1 / Leave a comment

Roger Scruton at The New Criterion: ‘Populism, VII: Representation & the people:‘

‘All this has left the conservative movement at an impasse. The leading virtue of conservative politics as I see it is the preference for procedure over ideological programs. Liberals tend to believe that government exists in order to lead the people into a better future, in which liberty, equality, social justice, the socialist millennium, or something of that kind will be realized.’

Is there a global conservative movement or moment happening right now? Different people, as parts of different and sometimes competing traditions have different things to conserve…

Megan McArdle at Bloomberg: ‘Best Health-Care Plan For Republicans?-Wait‘

‘A plan based on these ideas may, to be sure, end up covering fewer people than Obamacare currently does. But then Obamacare may end up covering fewer people than Obamacare currently does, because it seems to be slowly strangling the individual market.’

One goal was to get various poor and sick people as permanently ensconced and dependent on a vast expansion of federal authority as possible (or Medicaid, for now, while raiding Medicaid). Don’t mind the rotten deal and bad incentives for many other people that came about (rising health-care costs were unsustainable, after all).

If this meant a vast expansion of money, politics, and power into your life, limiting policy options, limiting many doctors’ freedom to serve you locally and directly, well, it was for your own good.

You see, the designers of the ACA have the knowledge, moral virtue and ability to make everyone’s lives better. Their principles are universally true, and descriptive of a future they can predict with as much accuracy as a formula predicts the probabilistic path of a particle. Hard choices, scarce resources, and basic human suffering are mostly a thing of the past.

Health-care is a right derived from these true principles, the knowledge to design the ACA just a matter of implementation now….

What was that again?

Ah yes, money, politics, and power.

Megan McArdle At Bloomberg: ‘A Sign That Obamacare Exchanges Are Failing’

February 16, 2017February 17, 2017 / chr1 / Leave a comment

Full piece here.

‘Molina’s losses suggest that instead of stabilizing, the exchanges are getting worse. There is no way to fix Obamacare without fixing the pool so that younger, healthier people buy insurance.’

For the most part, there’s no way to induce younger, healthier people into a system working against so many of their interests except by force of law and punishment; force which was barely concealed by particularly daft and short-lived political promises.

Pools of risk must deal with reality, and if you start from the idea of health-care as a right to be promised and guaranteed by a group of people in charge of government (claiming to speak for all People), rather than starting from the idea of health-care as a resource to best be distributed by price signals and market forces; by individuals making hard choices and sacrifices for themselves and their loved ones, then you’re more likely to get worse outcomes.

There’s also probably no way to really get the people who designed this law, the people who have pretty high IQ’s, trained at many of the best schools, to ever really examine the beliefs and principles that likely led to such failures, because that’s not how most people, most of the time, really operate.

More politics, and more people fighting over more politics to come…

Epstein on Obamacare’s Moral Blindness, the Obamacare Quagmire, and Watching Obamacare Unravel.

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’

Megan McArdle At Bloomberg: ‘Aetna’s Retreat From Obamacare Is More Than It Seems’

August 17, 2016August 17, 2016 / chr1 / Leave a comment

Full piece here.

McArdle:

‘Insurers cannot simply go on eating those losses forever. They certainly won’t do so for free. Unless the exchanges get a rapid infusion of healthier customers who pay substantial premiums without using much care, insurers are going to keep pulling out of the areas where they are losing money. Or at the very least, they will demand benefits from the government to make it worth their while to stay.’

Sigh.

As previously posted:

Pascal Emmanuel Gobry here.

‘One ray of sunshine might be an involuntary heightening of the contradictions: The structure of the Affordable Care Act, by removing health care decisions even further from consumers, all but ensures that costs will escalate even faster. At some point, most employers in America will only be able to afford catastrophic health insurance for their employees. If and when that irony busts onto the scene, perhaps real consumer dynamics will emerge, and perhaps America will stumble backward into a Singapore-style system.’

Or it might make this country stumble into the single-payer model after those who wrote the law ridiculously stretched the truth in order to sell it to the American people.

Sally Pipes has had experience with this kind of thing in Canada.

Once you make a scare economic good a ‘right,’ you’re just fighting over who controls the good, which, in most cases, leads to less for a vast majority, and the most advantage for those who need your money most in order to gain political power and influence.

Charlie Martin from a while ago:

‘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.’

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

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’…

Two Sunday Obamacare Links-Free Lunches

December 13, 2015December 13, 2015 / chr1 / Leave a comment

From The Economist:

‘Yet the share prices of America’s five biggest health insurers—UnitedHealthcare, Aetna, Humana, Cigna and Anthem—have all roughly tripled over the past five years. The big insurers have been consistently and highly profitable (see chart).’

Regulation has some winners, but it’s probably not you…

Megan McArdle on a serious problem with health-insurance:

‘Bankruptcy is terrible. But you’d probably pay a lot less for bankruptcy insurance than you would for insurance that actually made you healthier.’

Of course, this is the whole point of insurance…paying into a pool of risk to cover the losses if/when you face trouble.

The main problem with the ACA for people who think like me, is that coercion is used to round up everyone into a system that’s poorly, if not fatally, designed.

Free-lunches are on the menu, and we’re all now forced into a pact that pays for them with horrible cost/benefit ratios. If you already think there’s enough spending and taxation, regulation and back-room dealing in D.C….this law ain’t for you either:

‘You can’t really blame Obamacare for the fact that the most “affordable” insurance offers rather scanty coverage for the average user. Though of course, you can blame the law’s architects for overpromising. They should have been more honest, with themselves and with voters, about the limits of what they could actually do. But of course if they had been, the law probably would never have passed.’

Addition: Avik Roy summed it up nicely:

‘Any serious health reform program—left, right, or center—would involve some disruption of our existing health-coverage arrangements. What makes Obamacare such a deeply flawed piece of work is not that it disrupts our existing arrangements, but that it disrupts those arrangements by forcing people to buy costlier coverage.’

There are other ways to be on the ‘right-side of history,’ if what’s important to your identity is being a moral person during a time of identity politics.

We can all do better.

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

Some Sunday Obamacare Links

November 22, 2015 / chr1 / Leave a comment

Megan McArdle at Bloomberg: ‘Obamacare Insurers Are Suffering. That Won’t End Well.‘

As to the recent noise made by UnitedHealth:

‘That said, strategic positioning is obviously far from the whole story, or even the majority of it. UnitedHealth really is losing money on these policies right now. It really is seeing something that looks dangerously like adverse selection.’

I still think it’s crucial to advocate that the ACA, poorly written and hastily passed with one-party consent, is a law designed to plan over 1/6 of the American economy from one location, taking money earned by some and redistributing that money (time + labor) to others by way of a huge bureaucracy, politicians, and other interested parties.

The things you might dislike about health-care access now, in all probability, will increase: Huge networks, murky billing and rising prices. Some people will have access to care they previously didn’t but with awful cost/benefit outcomes.

We’ve taken many of the failures of the old system, the employer-based, jerry-rigged one, and vastly expanded Medicaid on top of it. This has also taken much choice, incentive, and opportunity away from the hardest working people, while trying to give the hardest working people’s stuff to the people who have less stuff.

This blog believes there’s no such thing as a free lunch.

The promises made reeked at the time (bending the cost-curve downwards), and a lot of numbers were tossed around to sway public opinion, and get the thing passed.

Such promises cannot possibly be met, and when they’re not, it’s reasonable to expect the people who made the promises will be all too happy to then regulate, ration, and control the system they’ve built, and huge parts of the economy, the political economy, and our lives.

They have the knowledge to do so, as far as they’re concerned.

Jim Pethokoukis quotes Robert Laszewski:

‘When are Obamacare apologists going to stop spinning the insurance exchange enrollment as some big victory that is running smoothly? Yes, Obamacare has brought the number of those uninsured down — because of the Medicaid expansion in those states that have taken it and because the poorest people eligible for the biggest exchange subsidies and lowest deductibles have found the program attractive. But that Obamacare has been a huge failure among the working class and middle-class — not to mention those who make too much for subsidies and have to pay the full cost for their expensive plans–has once again been confirmed.’

Previously: Charlie Martin here:

‘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.’

Everyone equally more miserable, really:

Still not a right: From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?…A Few Health Care Links-03/18/2010…Peter Suderman At The WSJ: ‘Obamacare And The Medicaid Mess’…From KeithHennessey.Com: ‘How To Repeal Obamacare’

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

February 18, 2015 / chr1 / Leave a comment

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.’

Single-Payer And Pies-In-The-Sky

December 20, 2014December 23, 2014 / chr1 / 2 Comments

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.

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

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

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

December 11, 2014December 13, 2014 / chr1 / 6 Comments

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.

Pascal Emmanuel Gobry At The American Interest: ‘What Americans Won’t Learn About Health Care’

October 10, 2014October 17, 2014 / chr1 / Leave a comment

Full piece here.

I tend to agree with the below, that the ACA will further remove health care decisions from many consumers.

‘One ray of sunshine might be an involuntary heightening of the contradictions: The structure of the Affordable Care Act, by removing health care decisions even further from consumers, all but ensures that costs will escalate even faster. At some point, most employers in America will only be able to afford catastrophic health insurance for their employees. If and when that irony busts onto the scene, perhaps real consumer dynamics will emerge, and perhaps America will stumble backward into a Singapore-style system.’

Many people have been brought onto Medicaid rolls under the ACA, and some onto the exchanges, but many incentives are simply backwards, such as inducing young people in their prime to buy-in with carrots and sticks. Under this law, you, me and everyone (in theory) will eventually be forced to join the government-run exchanges.

I could easily see a massive, health-care bureaucratic complex on the time horizon of a few decades; sprawling, good for the politically and culturally well-connected along with a large swathe of people who have enough money and freedom to access it and who would often have other options available, if necessary. They would be accessing near the top, too, where there would be higher-end facilities and better points of access, and this is also where the choice jobs and opportunities would be on the bureaucratic side, as I envision a generational conveyor belt moving through the suburbs, universities and on down to Washington (a permanent coalition of majority Democrats, if other bureaucracies offer any example). People with enough money always tend to have other options, and there would be winners and losers in this set-up just like any other.

Clearly, many poor and working poor would get more care than they got before, early childhood vaccinations and urgent care, some basic access and routine checkups, but again, in a world of limited resources, they would get promises but not always delivery. There would definitely be more availability for some and lots of brochures and ‘nudges’ that usually don’t work as advertised.

Of course, paying for these folks would be many others who are working poor and non-poor who could very easily be getting the short-end of the stick: Paying for all of this and perhaps getting very little in return and having no other options and virtually no political recourse. Such people would be paying for an immovable bureaucracy and more politicians controlling more of the money supply. They would be paying for more union control through the activists who benefit from the law along with the standard corruption and inefficiencies inherent in such systems. Such folks would sometimes be working against their own interests, disincentivized and unfree.

Richard Epstein looks pretty prescient on what the law’s specific challenges are:

‘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’

Epstein on Obamacare’s Moral Blindness, the Obamacare Quagmire, and Watching Obamacare Unravel.

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

Obamacare, The Islamic State & Vietnam-Three Friday Links

August 14, 2014 / chr1 / Leave a comment

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.’