TAPPED: KEEP MY SKIN OUT OF IT: Yesterday, I went to Cato to see right-wing health economist Arnold Kling debate the Washington Post's Sebastian Mallaby and contrarian progressive economist Jason Furman.... CofA argues that our health system suffers from an overuse of highly specialized and technologically advanced treatments. In that respect, it's undoubtedly correct -- modern medicine suffers from a grotesque lack of good treatment data, and I welcome Kling's proposal for a health care equivalent of the Congressional Budget Office (a nonpartisan research facility).
From there, we part. Kling's other solution relies on a massive increase in the amount of health costs that come out of pocket. The "very poor" would be subsidized, as would the "very sick" (neither term is defined in his book), but everyone else would be paying for their own care. This makes sense in a very specific sort of world -- one in which you believe consumers have the capacity to make rational health care decisions -- and to a very specific sort of person -- one who believes those who make mistakes with their health care should simply pay the costs, be they financial ruin or death.
I am not that sort of person, and I am highly dubious of that world. I see no evidence for the claim that a gas station manager in Bakersfield, California, will be able to second- or third-guess his cardiologist's recommendation of an angioplasty....
What so strikes me about the "skin-in-the-game" approach towards health care is its unmistakable cruelty. It will, of course, be sold in gleaming, positive terms -- "personal responsibility," "individual control," "the genius of the consumer," and all the rest. It will focus on how wise our choices can be, not how foolish they often are. But it abandons us with our mistakes -- it's a philosophy emphasizing the justness of consequences, an approach I find neither just nor realistic.
A good example of this came from Mallaby, who mocked Minnesota's insurance climate for mandating coverage of massage and wigs. (Minnesota, incidentally, has the lowest uninsured rate in the nation.) Ho, Ho, Ho. He had a good laugh over that one, I'm sure. Except the wigs are for chemotherapy survivors -- the sort of thing none of us expect to need, but may one day find necessary to continuing our lives. Good wigs, sadly, are very expensive, and few major businesses appreciate Cancer Chic among their employees.... And massages, which sounds silly, are often more effective, less costly, and safer than over-the-counter medicines in treating back pain. Few folks know that. Like Mallaby, they've not read the studies. Unlike Mallaby, they're not professional domestic policy thinkers...
I challenge the classification of Sebastian Mallaby as a "professional domestic policy thinker." It would seem to me that it would be more accurate to call him a lazy hack journamalist.
Duncan Black meditates on Sebastian Mallaby and becomes a mite... shrill:
Eschaton: Pundit Life: I was thinking more about Sebastian Mallaby's mocking of requiring insurers to cover wigs.... Here's a guy who undoubtedly has pretty damn good insurance through his employer. If an illness strikes and he's unable to continue the backbreaking work of typing a couple of columns per week about how other people have too much insurance at a very minimum, I'm sure his employment contract contains a long term disability rider to ensure he'll keep his insurance and a hefty percentage of his salary....
I'm not going to claim to have a deep understanding of living life as a member of the working poor - and, no, years of being a relatively impoverished grad student don't really qualify - but I do know the experience of someone in that situation is exactly like Mallaby's... not. To eat and feed their kids - let alone keep their insurance if they have it - they'll have to keep working as much as possible in jobs which require a bit more physical activity then flicking fingers across a keyboard, and a bit more contact with other people than a telecommute.
Memo to Cato: putting Sebastian Mallaby on a panel as a health care "expert" gains you brownie points among the journamalists of the Washington Post. It doesn't boost your reputation among the reality-based community.