Coyote Blog

My personal reaction was that Trump's speech was horrifying, a dystopian vision that bears no relationship to what is actually going on in this country (e.g. violent crime continues to fall, trade continues to make us wealthier, immigrants continue to make productive contributions, etc).  Peter Suderman has more in case you missed it.

But in Arnold Kling's 3-axis model of politics, the speech made perfect sense.   Trump has decided he is going to run hard on the civilization-barbarism axis.  The barbarians are at the gates, and his opponents are either too weak to deal with them or are actually in league with the barbarians.  He is the strong leader who will turn them back and make everyone safe again.  We're not going to trade with the barbarians, we are not going to treat with them, and we are not going to waste civil rights on them.  Ugh.  Trump is working hard to make me feel the victim, but I don't accept victim status.

I am not sure if this is marginally better or worse than what we are going to get at the Democratic Convention, where we will get four days of hearing that I personally am the bad guy and source of all misery in the world and the person that needs to be regulated harder and looted more furiously.   I almost prefer the Democratic approach, because at least evil is being done against me rather than in my name.

Good stuff from Peter Suderman at Reason

 In March, journalist Steven Brill published a lengthy piece in Time magazine on high medical bills, comparing hospital “chargemaster” rates—the listed prices—to the rates paid by Medicare. And over the weekend, Elisabeth Rosenthal compared U.S. prices for a variety of health services to the lower prices paid by other countries.

Both pieces offer essentially the same thesis: The U.S. spends too much on health care because the prices Americans pay for health care services are too high. And both implicitly nod toward more aggressive regulation of medical prices as a solution.

Part of the reason these pieces get so much attention is that most Americans don’t actually know much of anything at all about the prices they pay for health services. That’s because Americans don’t pay those prices themselves. Instead, they pay subsidized premiums for insurance provided through their employers, or they pay taxes and get Medicare or Medicaid. Even people who purchase unsubsidized insurance on the individual market don’t know much about the particular prices for specific health services. They may open their wallets for copays to health providers, or cover some expenses up to a certain annual amount, but in many if not most cases they are not paying a full, listed price out of pocket.

What that means is that, in an important sense, the “prices” for health care services in America are not really prices at all. A better way to label them might be reimbursements—planned by Medicare bureaucrats and powerful physician advisory groups, negotiated by insurers who keep a watchful eye on the prices that Medicare charges, and only very occasionally paid by individuals, few of whom are shopping based on price and service quality, and a handful of whom are ultra-wealthy foreigners charged fantastic rates because they can afford it.

This is the real problem with health care pricing in the U.S.: not the lack of sufficiently aggressive price controls, but the lack of meaningful price signals.

Much more at the link.  If they really want an interesting comparison, compare the prices of medical care not covered by insurance (actually pre-paid medical plans) in the US, and those that are -- e.g. for plastic surgery vs. other out-patient surgeries.

Don't say I have not been warning you.  For years.  Philip Klein via Peter Suderman:

...Bloomberg highlighted a comment from a supporter of the [soda] ban, who wrote, "Anyone who pays taxes and thus bears the health care costs of obesity should support this."

In a free society, individuals are able to take risks and make decisions detrimental to their own well-being -- be it smoking, drinking, excessive eating or anything else -- because they'll bear the ultimate costs of their decisions. But when government assumes a greater role in the health care system, suddenly there's a societal cost to individual risks. This provides an opening for those who believe in a paternalistic role for government to make their regulations seem pragmatic. Bloomberg used the "health care costs to taxpayers" argument during his previous drives to ban smoking in bars and restaurants and to outlaw the use of trans fats.

This was the trick behind cap-and-trade: Politicians know that the only real way to reduce energy usage is to raise its price much higher.  They also know that doing so would lose them their jobs, so instead of passing a simple carbon tax, they created a cap-and-trade system that would force private companies to be the bad guys.  They then try to hide this basic fact with a lot of distracting arm-waving about green jobs and wind power.

The new Obama health proposal, which looks a heck of a lot like the old Obama health proposal (same basic features, same lack of detail) plays a similar game.  Do you remember all that Obama talk about mysterious brilliant ways to reduce health care costs?  Where did they all go?  It turns out that the only real idea they had for reducing health care costs was to deny people care.  They just try to hide this with a lot of distracting arm-waving about gold-plated insurance and electronic medical records.

This denial of service is unpopular.  In fact, it is a great (and sad) irony that Obama is trying to harness anger at insurance companies that is caused mainly by denial of coverage for certain procedures with a system that will deny coverage for even more procedures.  Just like carbon taxes, Obama has fixed on a scheme where once again he sets up private enterprises to be the bad guys to give himself some sort of quasi-plausible deniability.  Obama is proposing artificial price caps on insurance premiums.  The inevitable result:

For example, as I have written elsewhere, artificially limiting premium growth allows the government to curtail spending while leaving the dirty work of withholding medical care to private insurers: "Premium caps, which Massachusetts governor Deval Patrick is currently threatening to impose, force private insurers to manage care more tightly "” i.e., to deny coverage for more services."  No doubt the Obama administration would lay the blame for coverage denials on private insurers and claim that such denials demonstrate the need for a so-called "public option."

Alan Reynolds has more.  And Peter Suderman.   And Phillip Klein points to an interesting anti-progressive angle:

Like the Senate bill, Obama's proposal doesn't include a strict employer mandate, but it does penalize businesses who do not offer insurance to workers who then get their insurance through the exchange. The Obama proposal provides more subsidies to small businesses, and helps mid-sized businesses by exempting the first 30 workers when calculating the tax, but large employers who do not offer coverage would face higher penalties under the Obama proposal. In the end, the tax will make it more expensive for large employers to hire lower income workers (who qualify for government subsidies), and thus exacerbate unemployment.

My read is that this all takes a hodge-podge mess and, uh, makes it even  hodgier-podgier.

By the way, my take is that there is only one health care cost reduction proposal worth talking about, and that is making individuals more responsible for their own health care costs, not less, thus creating incentives to do the thing we do for every other purchase we make:  shop around.