Jasper Smith

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Archive for the ‘Health Care’ Category

Ezra on Obama

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Ezra articulates his disappointment with the candidacy of Barrack Obama. Not surprisingly, given the fact that Ezra is the progressive blogosphere’s eminence grise on matters related to healthcare,  he focuses on Senator Obama’s dismal healthcare plan:

I understand that he needs to defend his plan, but he’s making an argument that, I imagine, future Republicans will quote back at progressive reformers. To me, this is worse than the Social Security stuff. At least there, he’s advocating a progressive policy, if buying into a Republican frame. Here, he’s constructing a conservative frame to defend a bad policy, a policy I believe his campaign regards as a mistake. He talks a lot about honesty. He should be honest. The lack of a mandate was a mistake, born out of caution, and he should rectify it. Hell, he’s already said that, if he could go back to the country’s beginning, he’d choose single-payer. So if he doesn’t want to turn and mimic Clinton’s position, and if he instead wants to say that having thought it through, the individual mandate is the wrong way to guarantee universality, and we should simply make insurance a right, guaranteed by the government because that’s what sort of country we are, and he’s sorry for letting consultants constrain him, that would be great. But to see Obama, day after day, argue against collective action and universality, is deeply disappointing, almost heartbreaking. He had the capacity to elevate those ideals, to do for them what Reagan did for individualism. He’s letting that opportunity, that potential, slip away.

Preach it, Ezra.

A progressive economic agenda happens to be my biggest priority in 2008. It’s not my only priority. But it is number one. It’s too bad that Obama isn’t as strong as he could be in this department, because his candidacy has a lot to offer the country. But I’m tired of mucking about: The tea leaves strongly favor a Democrat in 2008, and I want to make sure the Democrat taking the oath shares my priorities. If he’s still viable when the Massachusetts primary comes around, I’ll strongly consider John Edwards. But as of right now, I’m a Clinton supporter. Should Obama heed Ezra’s advice and publicly resharpen some of his domestic policy plans (especially on healthcare), I may reconsider. Heaven forbid a politician change his mind about something he’s plainly wrong about, so that he can now be right.

By the way, Hillary Clinton’s plan, which, we all acknowledge, was basically right out of Edwards’s playbook (with one or two improvements), was politically very astutely written and presented. My own take on the Hillarycare fiasco of 1993 is that its biggest flaw was that it didn’t get the politics of healthcare right. So, her efforts this time around tell me that she has learned from her mistakes, and that having failed the first time around, Hillary Clinton is — as she claims, and contrary to her critics — more, not less, likely to succeed in giving every American meaningful healthcare coverage.

We are correct in avoiding people who make the same mistake again and again. But people who learn from their mistakes are usually some of the most effective people on offer.

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November 26, 2007 at 5:58 pm

Obama v. Clinton: deciding factors

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Barrack Obama supporter Matt Yglesias has been fairly tough on Hillary Clinton lately. Foreign policy wonk that he is, Matt’s objections to Clinton, not surprisingly, focus on this area:

When I see a race between two politicians, one of whom got Iraq wrong and one of whom got it right, to me that establishes a presumption in favor of the candidate who got it right, no matter whose husband the wrong one is. When it turns out that the one who got it wrong also has a group of advisors heavily weighted toward the group of pro-war “experts” who helped push so many Democratic politicians into taking her wrong position on the war in 2002, that re-enforces my presumption. When the one who got it right is closer to a circle of people who were cast out of favor due to their opposition to the war or willingness to associate with Very Shrill Howard Dean, that re-enforces my presumption. Stuff like the Kyl-Lieberman vote, the funny business on nuclear weapons, the “naive and irresponsible” bit all further re-enforces my presumption. And I think once you look at it that way, the whole race looks different. There’s been a ton of commentary about how Barack Obama hasn’t said or done anything to debunk people’s presumption that Hillary Clinton should be the nominee. And that appears to be true. But what if you don’t start with that presumption? And I don’t think we should. To me, the presumption that a candidate who can say he has a record of sound foreign policy judgment that can be contrasted with Republican X’s record of support for Bush administration fiascos makes a lot more sense than the presumption that Clinton should get the nomination.

All good points by Matt; this line of thinking could certainly seal the deal in favor of Obama for a person favorably disposed toward either of the two Democratic frontrunners, if such a person is basing his/her vote primarily on foreign policy and national defense.

I know there’s an argument out there that foreign policy is exactly what you should base your decision on, given the executive branch’s primacy in this area, and Congress’s prominence in domestic affairs. But dammit, the country’s domestic political economy is might screwed up at the moment, and, personally, I’m really jonesing for sanity, competence and proper priorities in this area, too. And here — at least from the little I’ve gleaned about Senator Obama’s positions from following the campaign — his instincts really seem worryingly off-kilter. Especially for someone who cut his political teeth as a community organizer. Obama’s views on Social Security strike me as particularly ill-informed, and his proposal to remove millions of old people from the income tax rolls is just bizarre. And his health care proposal is frankly awful. In a word, Obama seems to me like a real rookie when it comes to bread and butter issues.

Anyway, none of this may make much difference if a President Obama allows a more heavily Democratic Congress to set the agenda on domestic affairs, and said Congress is lead by Democrats with sound principles. But I’d feel much more comfortable voting for Senator Obama in the primary were he to show more substance on kitchen table issues — even if that meant — heaven forbid — modifying some of his earlier positions and risking the dreaded charge of flip-floppery.

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November 20, 2007 at 5:51 pm

Long live flexicurity

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A great Ezra Klein comment thread was generated from his post entitled: Wal-Mart and the Mom-and-Pops. I won’t do a major excerpt (read the whole thing), but will just mention that a sub-discussion got involved using the example of Wal-Mart, and its efforts to browbeat the maker of Crest into lowering prices, and how this cycle plays out in the form of poor wages and benefits for workers. Anyway, one commenter opined that

It’s a stupid argument that Wal-Mart or Crest or any other company can thrive only by treating workers like shit and paying them little.

Yes, but who exactly is arguing that undervaluing workers is the “only” way a company can thrive? Talk about straw man arguments. Obviously plenty of enormously successful private sector employers in the United States pay excellent wages and benefits. Indeed, American workers are some of the world’s most expensive. The key question is: what if any role should government play in mandating how much workers should cost.

While it may be true that sometimes firms can prosper quite nicely while paying a relatively high price for labor (see Ford Motor Company circa 1928) it’s equally true that employers can sometimes perform pretty dismally while overpaying for labor (see Ford Motor Company circa 2007). All in all I’d just as soon have a firm’s owners, and not government, determine how much they can afford to pay for labor. I doubt Goldman Sachs or Boeing or IBM or Pfizer are paying more than they have to for their American workers. It’s just that the going rate for skill sets in those fields is high — a lot higher than the going rate for the skill sets involved in stacking shelves or flipping burgers.

Not that workers doing these types of less skill-intensive tasks ought to be treated badly. Far from it. They ought to enjoy — like their counterparts in other rich countries — the generous protections of a robust, taxpayer-supported safety net. The big advantage to relying on government for social protections — rather than private sector mandates — is that government is too big to fail. One can certainly imagine a GM, say, or a Caterpillar having trouble paying for healthcare or pensions. But the United States government is very unlikely to give up ownership of its printing presses.

Very robust safety net + very free markets: the Nordics have it right.

Written by Jasper

September 6, 2007 at 5:41 pm

A false choice?

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Will Wilkinson is skeptical of Ezra Klein’s claims about middle class economic anxiety. He also believes the benefits flowing from globalization strongly outweigh the negatives:

I think lots of firms will be seeking less-expensive foreign labor, that this will have a significant effect on the jobs available to Americans, but also on the price of many goods and services (down) and on the incentives to acquire new and/or improved skills (stronger).

Although I don’t disagree with any of this, and although I’m a committed fan of globalization, I’m skeptical that a government guarantee of health insurance, say, or a dollop of wage replacement insurance for those too old to make the transition into a new career would do all that much to blunt the incentives to upgrade skills. Moreover, I’m increasingly convinced that lack of health/economic security is exerting at least some negative impact on the ability of Americans to fully partake of the so-called “Ebay economy.”

I guess what I’m saying is that I suspect to a substantial degree we can have our cake and it eat it, too: Sam’s Club protections combined with Brave New Economy opportunities and efficiency. I reject the notion that we must choose either/or because it least appears to my eyes that a number of other places (New Zealand? Ireland? Canada?) are rejecting this false choice to their great benefit.

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September 3, 2007 at 4:34 pm

Survival of the fattest

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“British School Kids Shun Healthy Foods” thunders this AP headline picked up by The NY Times:

Please sir, we don’t want any more! Naked Chef Jamie Oliver’s push for healthier foods to replace greasy french fries, chicken nuggets and turkey twizzlers on British school menus is in a twist. Apparently, the students aren’t anxious to try it. The celebrity chef has led a nationwide campaign to improve the quality of food served in schools, demanding more money for meals and a ban on junk food. His TV series ”Jamie’s School Dinners” exposed how cafeteria menus relied on prepared foods like chicken nuggets or the turkey twizzler — a corkscrew of mainly reconstituted turkey scraps and preservatives. Such meals, usually served with piles of fatty french fries, could cost as little as 66 cents. Spurred to action, the government set up the School Food Trust in 2005 to help schools improve the quality of their food. Sample menus for the new program included vegetarian quiche, lentil burgers and mushroom tagliatelle. But more than 424,000 students opted out of their school meal plans in the first two years of the program, according to government figures obtained by the opposition Liberal Democrats and released Monday.

You mean to tell me that a government’s efforts to get a group of people to eat healthily is being trumped by homo sapien’s five million year evolutionary history — you know, the one that favored the survival of those who love to eat fatty, carb-laden, calorie-rich foods to better ward off the next episode of famine?

I’m shocked, I tell you, simply shocked!

Written by Jasper

September 3, 2007 at 3:19 pm

Beggar thy neighbor

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Kevin Drum brings to our attention an LA Times opinion piece by one L. J. Williamson, who apparently is miffed at the efforts of the lunch ladies to get a little health insurance:

Part-time food service employees are seeking the same health benefits — including coverage for their families — that their full-time counterparts enjoy. Extending these benefits to cafeteria staff who currently work only three hours a day would cost an estimated $40 million a year, according to school board calculations…This is fat that the food service’s too-lean budget simply doesn’t have. If health benefits were extended to these part-time workers, the CFPA estimates it would mean that the per-plate meal budget would be reduced from 85 cents to 49 cents. Making healthy food available for that amount would take a miracle of biblical proportions. So we’d be improving the healthcare of nearly 2,000 part-time workers at the expense of the 500,000 children who eat in public school cafeterias every day.

In reply comes a morning rant from Kevin:

It’s true that the growing gap between public workers and private workers is a real problem. In the past, there was something of a tradeoff: public sector workers generally got paid less than private sector workers but made up for it with job security and benefits. Today, though, public workers generally get higher salaries and better benefits and more vacation and earlier retirement and more lucrative pension packages compared to comparable private sector workers. And private sector workers are understandably annoyed by this. But their annoyance would be better directed not at the lucky public sector workers, but at the mahogany row executives and conservative politicians who pretend that the only possible use for the mountains of cash generated by decades of economic growth is to give it all to mahogany row executives and the billionaires who contribute to conservative politicians.

That Drum fellow sure can write.

Written by Jasper

August 28, 2007 at 7:17 pm

Babies and bath water

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Cafe Hayek brings to Jasper’s attention a John Stossel column on the how America’s healthcare system stacks up in world rankings. Here’s a little excerpt:

The New York Times recently declared “the disturbing truth … that … the United States is a laggard not a leader in providing good medical care.” As usual, the Times editors get it wrong. They find evidence in a 2000 World Health Organization (WHO) rating of 191 nations and a Commonwealth Fund study of wealthy nations published last May. In the WHO rankings, the United States finished 37th, behind nations like Morocco, Cyprus and Costa Rica. Finishing first and second were France and Italy. Michael Moore makes much of this in his movie “Sicko.” The Commonwealth Fund looked at Australia, Canada, Germany, New Zealand, the United Kingdom and the United States — and ranked the U.S. last or next to last on all but one criterion. So the verdict is in. The vaunted U.S. medical system is one of the worst. But there’s less to these studies than meets the eye. They measure something other than quality of medical care. So saying that the U.S. finished behind those other countries is misleading. First let’s acknowledge that the U.S. medical system has serious problems. But the problems stem from departures from free-market principles. The system is riddled with tax manipulation, costly insurance mandates and bureaucratic interference. Most important, six out of seven health-care dollars are spent by third parties, which means that most consumers exercise no cost-consciousness. As Milton Friedman always pointed out, no one spends other people’s money as carefully as he spends his own.

This, shockingly, got a nice frothy libertarian contra socialist comment debate going. Characteristic of the debate is the following claim:

The US healthcare system is the best in the world. Period. Better doctors, better/more accessible delivery, better research and development, better perfusion, better administration, better response time, better trained professionals (just not enough), better overall in virtually every single measurable metric.

Okay, let’s get one thing straight: what we have in the United States is certainly not the best healthcare system by “every single measurable metric.” What I think is more accurate to say is that the product delivered by this system is often superior — but the system for delivering that product is creaky, inefficient, and in need of reform. The libertarian pro status quo folks are aping the rigid, “blinders on” stance of their left wing opponents in the pro single payer camp. Both approaches are flawed.

While the actual product delivered by the US healthcare system is very often the best in the world, that system is nonetheless subject to pressures and difficulties that are far less severe and even non-existent in other rich world healthcare systems. Generally speaking, in those other systems, people don’t get denied coverage for preexisting conditions, but in the US this is a serious issue. As is the related problem of job lock. Moreover, in the US, a significant portion of the population lacks medical insurance at any given time; depending on whose statistics you cite that number is anywhere from 7% to 15% of the public. In the rest of the rich world that number approaches zero. In the US, administrative expenses — such as the money devoted to finding out which people ought not be sold an insurance policy — are a tremendous drain of resources. Again, these numbers have consistently been shown to be much lower in other rich countries. And here in the US, medical expenses are a significant driver of personal bankruptcy and financial ruin. Again, this simply isn’t the case elsewhere. And by “other” systems we’re not necessarily talking about evil socialist schemes. France, Australia and Switzerland, to give a few examples, embrace a wide degree of private sector participation in healthcare, and yet manage to avoid the pitfalls of the US model. And their systems deliver results broadly in line with the American experience. For a lot less money.

I agree with many libertarians about the numerous advantages America consumers enjoy because of the heavy participation of non-governmental actors in the delivery of healthcare. I also strongly agree with the notion, that, in any efforts to enact reform, we should refrain from throwing out the private sector baby with the bath water. But nonetheless it’s time to change that increasingly dirty water.

Written by Jasper

August 26, 2007 at 4:06 pm

McArdle on the morality of healthcare finance

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Speaking of Megan, I’ll point readers to a long and rambling post by this (usually) very excellent blogger on healthcare — a subject near and dear to all the wonkishly minded these days. It’s frankly a bit sprawling and unfocused, so I’ll just cut to the chase — namely, my reaction. And my reaction is that trying to look at the particulars of health care finance as a moral issue is tiresome in the extreme.

There’s nothing more important than considerations of moral philosophy, but something as dry and policy wonkish as health insurance should be reserved for the utilitarians.

In my view making sure everybody has robust insurance coverage via the use of taxpayer money just makes sense. It’s not necessary to talk about justice.

If the US were to enact guaranteed, universal health insurance — adapting the best practices in place throughout the rich world for use in America — the country’s wealthy would hardly be worse off, even if their taxes were to increase. If you don’t believe this, ask rich folks in Australia or Denmark whether or not they enjoy high standards of living. The wealthy can afford to pay more in taxes. When you’ve got a lot of money you can afford things.

Middle and upper middle class people don’t have much room in the family budget for higher taxes, but theirs wouldn’t have to increase very much – and in amny cases they’d come out ahead (I guarantee you some poor schmuck paying 1,400 bucks a month for COBRA coverage would be better off financially were he to pocket the premium and pay Ontario levels of taxation). And the freedom — yes, let’s call it by it’s real name — the freedom to never have to worry about losing your coverage; the freedom from job lock; the freedom to join an exciting but risky start up; the freedom from the threat of disease-induced penury; the freedom of knowing your children’s health insurance can never be canceled — the value of such freedoms would be priceless to average people.

And, the poor, of course, would come out ahead with a robust system of universal health insurance — no calculus required.

Oh, and lots of businesses would realize a net advantage, as well.

Let’s keep it simple. Leave the discussions about angels and pinheads for the philosophers. The rest of us can debate and discuss costs and benefits.

Written by Jasper

August 23, 2007 at 10:10 pm

America: the healthcare spendthrift

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Kevin Drum ponders the issue of healthcare costs, and the reliance on life expectancy as a metric:

On a (marginally) related note, though, one thing that always bugs me about these discussions is their focus on mortality. In the great scheme of things that might be worth focusing on since a large portion of our healthcare dollars are spent in the last year or two of life. But extending life is hardly the only — or even the primary — purpose of healthcare. I tore a meniscus in my knee a few years ago and ended up getting $10,000 worth of arthroscopic surgery on it. It didn’t extend my life by a single minute, but it sure did improve my life. Ditto for things like dental care, antidepressives, athsma inhalers, cortisone shots, and all those infamous hip replacements. They cost a lot of money, but they don’t really have much of an effect on mortality at all. Still pretty nice to have around, though.

Good point, Kevin. I’ve always thought the same thing, which is one reason I’ve never had a problem with commercial advertising by drug companies. I mean, if you’ve got a product that will improve somebody’s quality of life, why shouldn’t you be able to market it? For the same reason, if we ever get everybody covered with medical insurance in this country, we all ought to take a chill pill over the issue of medical spending. Sure it’s likely to increase as a percentage of GDP for the foreseeable future. But if that spending is enhancing quality of life, why is that a bad thing?

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August 15, 2007 at 9:16 pm

Bill Richardson says yes to cannabis

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Good for Bill Richardson:

New Mexico Gov. Bill Richardson says he plans to sign a medical marijuana bill despite the controversy surrounding it. “Is it risky? So what if it is risky. It’s the right thing to do,” the Democratic presidential candidate told the Albuquerque Journal. “Sure I’ll catch national grief over this. But I don’t tailor my style, or what I stand for, to primary states.” The bill, which cleared the New Mexico Legislature Wednesday, would allow state residents suffering from certain debilitating medical problems to be state-certified for medical marijuana use to ease their symptoms, the newspaper said. Supporters say the measure would affect a relatively small number of people. “What we are talking about is 160 people in deep pain, and it only affects them,” Richardson said.

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March 17, 2007 at 9:05 am

Just say no

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Megan McArdle questions the wisdom of the “just say no” approach to alcohol and drug education, and also doubts the possibilities for teaching our young people the virtues of moderation:

Let’s be honest: for many of us, our happiest college memories ended up face down in a toilet. But that’s neither here nor there. DARE’s job is to prevent drug addiction, not maximise the net amount of happiness in society. From what I know of the programme, it doesn’t actually do either very well, or in fact, at all. But I misdoubt it would be any better if it preached moderation.Kids binge drink because they are gigantic bundles of anxious energy, and drinking allows them to free their id from its neurotic chains for a while without social consequences. Well, I mean, there are social consequences, of course, but you can get away with setting cars on fire or sleeping with half the track team with surprisingly little social opprobrium. (…)

So colour me sceptical that we could prevent binge drinking if we could only teach 18 year olds to drink like 35 year olds.

I’m not so sure I agree with Megan on this one. I tend to think oo much emphasis is put on avoiding intoxicants. The emphasis rather should be on avoiding intoxication.

In other words, their message should be that getting drunk/stoned/high/intoxicated is very very bad, dangerous, etc., and that sobriety is very very good, positive, integral to financial and social success, etc.

But by banging the drum incessantly on a “stay away from this or that substance at all costs” message, they emphasize the wrong strategy.

I strongly suspect the number of successful, non-addicted people who have tried cannabis, or who enjoy a beer or a glass of wine now and then, vastly outnumbers the number of successful, non-addicted people who who have never tried intoxicants. It seems like becoming a member of the former group is a more realistic option than becoming a member of the latter, and is likely to be the basis of a more successful public health strategy.

I honestly think that many young people really never hear a sensible message about why it’s dangerous or foolhardy to get drunk or high. They do hear messages about abstaining from drugs and alcohol, but they’re likewise aware than most adults don’t follow this advice. So, when they, too, decide not to eschew trying these substances, they possess little in the way of awareness of the critical importance of moderation.

Written by Jasper

October 31, 2006 at 9:37 am

Posted in Health Care, Policy