Why Oh Why Can't We Have a Better Press Corps? (Yet Another Washington Post Edition)

Ezra Klein:

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.

Clueless pundits.

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.

Comments

[Tyrone Slothrop]

A minor correction:

Ezra later acknowledged that the two terms were defined.

Carry on.

[Blissex]

«But it abandons us with our mistakes -- it's a philosophy emphasizing the justness of consequences, an approach I find neither just nor realistic.»

Well, the plan here is that some people, those of ample means, can afford to make mistakes and get second chances and escape consequences, and the others cannot.

Now the role of insurance, especially mass insurance, is to pool risk so everybody gets a second chance. And the role of state programs in this is to make the risk pooling work for everybody, because mandatory mass insurance avoids self-selection either way and other moral hazards.

But those with the means to think they don't need insurance see paying into a risk pooling arrangement as theft, and want to call themselves out. And possibly call out everybody else too, so that while they are secure everybody else is not.

It is nothing news, it is the ''f*ck you, I am fully vested'' point of view. The fully vested who are the contributing class of the conservative movement don't need group insurance for themselves and don't want it for anybody else either.

[SZ]

I'd be interested in hearing your [both Brad's and my fellow posters'] thoughts on the Singaporean model of health care. The government forces people to contribute $1000 per year into a health care savings account. There also is automatic coverage for any necessary medical procedure above a certain value, and all emergency care. The health care savings accounts grow each year, and people can choose to spend it on those things in which it is in their power to shop around (including things like dental care, eye care, etc.). The basic idea is to leave consumers to their own choices when those choices can be made reasonably well informed, and not in situations regarding heart attacks, etc. Ideally, young people who do not use $1000 a year in medical procedures would save up their money, and then use it when they’re older.

I'll admit it, I'm an ignoramus when it comes to heath care economics, but this system seems to make sense to me. It also seems achievable politically. What do you all think?

-SZ, who being an ignoramus is slightly more qualified to discuss heath care policy than Sebastian Mallaby. He eagerly awaits his invitation to speak at the next Cato panel.

[Esq.]

The "moral hazard" theory of reducing health care expenditures will have the effect of reducing preventive care most of all. Is it so hard to figure out that if you make people pay out of pocket, people won’t go unless and until they are sick. Yet, it is the standard conservative “free market” reform.

Consequently, the demand for more expensive curative care will be increased, driving up the total cost of health care.

[entlord]

Mallaby and his dudgeon over health insurance covering wigs reminds me of a local weekly's editor when marathons first began, as common policy, to accomodate paraplegics. He climbed onto a similar high horse as he editorialized that in athletic events, "Everyone should be equal and paraplegics should not have the unfair advantage of being able to run the entire race sitting down". Mallory seems to have the same intellectual depth as this other fellow.

[Jonathan Goldberg]

Arnold Kling lost his credibility with me when he wrote that he wasn't sure economists should "let themselves be bullied" into accepting global warming. After reading that I lost all interest in anything else he has to say.

[spencer]

Kling is one of those liberaterians that looks at the capitalism of 1848 that Marx
described and believes that it was the ideal system that we should return to.

He really believes in all the assumptions of the pure competition model.

[Les Brunswick]

Regarding the rationality of personal health care decisions, let us remember that the behaviorial economists have shown quite decisively that the rational actor model often does not apply to economic decisions.

Has anyone ever studied the rationality of personal health care decisions? The conservative healthcare nutcases seem to assume there is no need for research in this area and everything we need to know can be deduced through armchair analysis.

[Christopher Ball]

Klein is wrong, however. Minnesota mandates wigs or "scalp hair prostheses" for people suffering from alopecia areata, not for chemotherapy. See http://www.revisor.leg.state.mn.us/stats/62A/28.html

Mallaby is wrong too (at least as reported by Klein). If Minnesota mandates coverage for "massage" it is odd that the Minnesota code does not mention it. Minnesota does mandate coverage for chiropractic services despite the fact that the studies that find value from massage therapy find no such value to chiropractic treatment.

[lessthanamused]

This guy has a problem with the way health care dollars are spent in Minnesota, of all states? Yes, he is a fool. SZ: I imagine things are alot cheaper at the point of service (hospital) level in Singapore. In fact, at least one local business in my area is now outsourcing routine surgical procedures to India. No joke.

[Douglas Knight]

lessthanamused:
Singapore is not India. It is about as rich as Spain.