Facebook
Twitter
Print This Post Print This Post

Lessons from the Health Plan Collapse

The depth of the loss is probably exaggerated.  It is still very early in the term of this administration and the humiliation will subside. Still, there are some harsh lessons that should be learned .

President Trump may have found the limits of bluster.  When it comes to critical policy, the details do matter; you cannot just declare that your bill will be great.

The ACA front loaded the benefits and rear loaded the costs. The Republicans found it tough to take away benefits.  Like bricks on a pickup truck, we keep adding bricks beyond the load capacity and then only blame the last few bricks when the axle snaps.  The problem with health care is an accumulation of mandates, regulations, perverse tax incentives, and wishful thinking. It is a Rube Goldberg cluster of attempts to hide the true costs of health care, so that politicians can make promises without paying for it.

Apparently, the Republican opposition to this bill was that they were not removing enough bricks from the truck.  Perhaps they need a heavier duty truck with a bigger load capacity. For the left that means single payer, but that only further hides true costs by removing the function of prices and incentives. For me it means restoring consumer power and facing economic reality. Insurance is not health care, mandates cost money, and restricting supply while increasing demand and money flow will cost you somehow.  This is the economic equivalent of gravity.

Perhaps the mistake was to take a systemic approach rather than address the component problems in separate bills.  Cost and access are related, but require very difference approaches.  In the focus on cost and access we do not want to sacrifice  innovation, quality and service.

The Republicans who have swept state governments and shown much fiscal success in that arena are facing much greater obstacles with national power.  The difficulty of assembling a collation on a national level is much different. Lawmakers must address fears and concerns that may be much less prevalent in their district. Senators and Congressmen face a powerful national media that local lawmakers usually avoid.  This is a fact to be accepted and requires an exceptional ability to communicate concepts of policy in commonly understood language.  Coverage with no providers is not a solution.  Lower premiums with outrageous deductibles is not cheaper.

As Glenn Harlan Reynold notes, the Republicans should have their health care bill, their tax reform plan, and their infrastructure bills lined up like planes on a runway. The reality of passing legislation is more complicated, but they are better off failing early, if they learn from it and keep pushing.

They will not succeed by rushing, blustering, and sacrificing transparency.  If they repeat the mistakes of the last administration they will reap the same rewards.

Other recommended readings on health care reform

It’s time to drag healthcare out of the 19th century

Supply Side Health Care Reform

Ditch Obamacare and Don’t stop there

Republicans Should Kill Obamacare or Let it Die

Print This Post Print This Post

The Capitalist Paradox

from Kevin Williamson in National Review, The Social Machine:

The people who have an explicit legal obligation to work not on our behalf but on behalf of their shareholders do a pretty good job of giving us what we want; the people who vow to work on our behalf do not. That is a paradox only if you do not think about it too much, and not thinking about it too much is the business that politicians are in.

If capitalism — which is to say, human ingenuity set free to follow its own natural course — is a kind of social machine, then politicians are something like children who take apart complex machines without understanding what they do or how to put them back together. (At their worst, they are simply saboteurs.) When they rail against capitalism, automation, trade, and the like, they resemble nothing so much as those hominids at the beginning of 2001: A Space Odyssey, shrieking hysterically at something that is simply beyond their comprehension.

 

Print This Post Print This Post

Unacceptable Decency

A gem from Kevin Williamson at National Review, Fake Hate Crimes:

The Left desperately wants Americans to be indecent people who go around attacking Muslims and foreigners with funny names, but, by and large, we aren’t. Campus feminists desperately want “rape culture” to be a reality, and so they invent phony rape stories from Duke to the University of Virginia, making sure to target fraternities and sports teams, which are to them symbols of patriarchy. These stories are given currency and credence by incompetent journalists such as Sabrina Erdely and her editors at Rolling Stone, none of whom had the intelligence or grit to question the transparently false claims made in “A Rape on Campus.”

Here is the thing: It is not only the hate crimes that are fake. For the most part, the hate they are intended to highlight is fake, too. No matter how many times Jamelle Bouie of Slate insists that American conservatism is an ideology founded in white supremacy, no matter how many times the halfwits at Salon claim that the neo-Confederate impulse is the motive behind Republican policy ideas, no matter how passionately every third-rate intellectual from Bennington College believes that “all heterosexual sex is rape,” it is not so. These claims are as fictitious as the made-up rape at the University of Virginia — they are simply more general.

 

Print This Post Print This Post

Origin of ‘Neoconservative’

from Word Games by Kevin Williamson in National Review

“Neoconservative” was first brought to popular usage in the American context by left-wing intellectuals (the socialist Michael Harrington most prominent among them) to describe the thinking of a few critics of American progressivism and the American Left — especially Irving Kristol and Daniel Patrick Moynihan — who didn’t smell like conservatives. The classical conservative — the cartoon conservative — was Babbitt, a Midwestern businessman who was Republican, conformist, and, above all, anti-intellectual. Kristol was a Jewish intellectual from New York and a former Trotskyist; Moynihan was a Kennedy confidante, a diplomat, and, eventually, a Democratic senator. The neoconservatives, in essence, were those who began criticizing progressivism from within. Eventually Irving Kristol and Norman Podhoretz, among others, would embrace the label.

Print This Post Print This Post

Health Care in Concrete

From Megan McArdle at Bloomberg, Republicans Should Kill Obamacare or Let it Die:

Some forms of government policy are built of political concrete. Once done, they cannot be renovated, added to or even destroyed without immense cost; for that reason, they tend to go on much as they always have, for good or for ill.

This was the problem that Democrats faced with Obamacare. Other countries, it was often observed, had a national guarantee of health insurance; surely, we could build a system very much like those. But the other countries had built their systems earlier, when there weren’t so many concrete towers already in the way. By the time Obamacare came on the scene, America already had government programs that were propping up health care for almost everyone in the country: tax-subsidized employer-sponsored health insurance, Medicare, Medicaid, the VA. No one was willing to shoulder the cost of knocking those things down and designing a rational, well-built structure to take their place, so instead the administration threw up an annex next to the Medicaid edifice, and tore down the little remaining patch of ground that wasn’t government-subsidized, and threw up a new tower to hold its residents.

 The planning was haphazard, the work shoddily done, and the result kept threatening to collapse.

And yet it was locked in. That whole “political concrete” thing.  For the enthusiasts, the very difficulty of alteration was not a bug but a feature, because it meant that it would be hard for Republicans to undo. So we were all left with a subpar system that is difficult to either repair or replace.

You do not fix a concrete eyesore in stages. You either knock it down, or you leave it where it is and learn to live with its flaws. If Republicans want to actually do a radical renovation of our nation’s health policy architecture, then they should get a reasonable estimate of the costs, grit their teeth, and go ahead and actually build something sound, and enduring, while demolishing substantial portions of the ugly and unsustainable mess we currently have.

HKO

I also contend that viewing it as a broad systemic problem may be misleading.  A few underwriting rules would solve the uninsured questions. The poor could actually have coverage purchased for them so they will not be able to game the pool.

But this requires that the tough decisions must be made, not delegated and hidden in a rat hole of mandates and indirect subsidies. What will and will not be covered.

The first rule of politics is to ignore the first rule of economics.