The Elephant in the Health Insurance Room
The CBO is an imperfect body and should be recognized as such.
JOHN STEELE GORDON 2017-03-16
Washington is all atwitter (a word coined in 1833, but with new meaning in the 21st century) over the Congressional Budget Office scoring of the health bill introduced in the House recently. As has been pointed out, the CBO has a terrible track record when it comes to predicting the future ten years out. It predicted far higher enrollment in Obamacare than came about, so why should we put any faith in its prediction of lost coverage under the new health bill?
When it comes right down to it, of course, ten-year projections aren’t worth the powder to blow them up, as a simple thought experiment shows. Had the CBO existed in 1928, how accurate do you think their ten-year projections made that year would have been?
The CBO also badly missed the mark when it came to Medicare Part D (drug coverage) that started in 2006. The CBO estimated that in the first year there would be 7 million enrollees. There were 24 million. And while the CBO is notorious for underestimating future costs of government programs, it overestimated costs ten years out for Medicare Part D by a whopping 40 percent.
The main reason costs came in much lower than expected is that Medicare Part D allows insurance companies providing the coverage to compete with each other in terms of price. What a concept! That’s why every fall, during the period when people can enroll, drop out, or change providers, television is crawling with insurance company ads trying to entice customers to their Medicare Part D coverage.
When was the last time you saw an ad for regular health insurance? Exactly never. There is no price competition in the health insurance market, which goes a very long way to explaining why medical costs keep ratcheting up. So the elephant in the room of health insurance reform, the elephant that almost everyone in Washington is studiously ignoring, is the lack of price discovery.
As former senator Tom Coburn (a physician by training) explains, as long as the costs of medical procedures are kept secret, no health insurance reform is really possible. Make health care providers post their prices, and those prices, now wildly disparate, will quickly begin to converge towards the low end once customers can find out where they can get a better deal.
The problem, of course, is that insurance companies and hospitals don’t want prices to be public and they are both very powerful lobbies in Washington. Welcome to democracy.
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The Elephant in the Health Insurance Room
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Conservatism’s Contradictions
Ted Cruz channels the right's id.
Noah Rothman 2018-09-24
Ted Cruz thought he had Beto O’Rourke right where he wanted him. Without commentary, Cruz tweeted a video of his Democratic rival expressing outrage over the killing of Botham Shem Jean–an African-American man shot dead in his own apartment by an off-duty police officer.
“When we all want justice and the facts and the information to make an informed decision, what is released to the public?” O’Rourke asked as the crowd of predominantly black church-goers. “That he had a small amount of marijuana in his kitchen. How can that be just in this country? How can we continue to lose the lives of unarmed black men in the United States of America at the hands of white police officers? That is not justice. That is not us.”
Dallas Police Officer Amber Guyger had allegedly mistaken her victim’s apartment for her own when she barged in and shot Jean dead. An investigation into the killing revealed that the deceased had marijuana in his possession, but the reaction this revelation inspired among observes was widespread confusion over its relevance. Guyger had no warrant and no cause to enter this private residence, and it was Guyer who instigated the confrontation that resulted in this deadly altercation. Shortly after this incident, Guyger was arrested, charged with manslaughter, and fired from the Dallas Police Department.
If Cruz had hoped to rally conservatives to Guyger’s side, he failed miserably. “Lack of outrage about this case is disgraceful,” wrote Reagan White House staffer and author Mona Charen. “The man was gunned down in his own home,” marveled National Review’s David French. “This is the sad distillation of what Ted Cruz has become,” the Atlantic’s Conor Friedersdorf wrote of a lawmaker “who criticizes his opponent for… saying it’s unjust for police to needlessly burst into someone’s apartment and kill them.” But Cruz’s target audience was not the conservative and libertarian intelligentsia. Nor was he simply broadcasting winks and nods toward racially reactionary whites, as the usual suspects on the left insisted. The Texas senator was invoking a style of cultural conservatism that is often at odds with philosophical conservatism.
The foundational conservative ethos is rooted in healthy fear. Conservatives fear the unchecked power of the state, and they are keen to rein it in. They fear the unintended consequences of well-intentioned lawmakers and bureaucrats whose efforts to “do something” so often backfire. They fear the immodest and prideful who do not cherish the traditions that buttress civil society and are inclined to pursue change for change’s sake. Conservatives would first do no harm because their first instinct is to do nothing at all.
That worldview is often incompatible with some of social conservatism’s diktats, and this is most evident in how lawmakers approach issues related to law and order. It is difficult to reconcile the criminalization of a substance on the federal level that is often legal at the state level, a substance that remains classified as a schedule 1 drug despite Congress’s declaration that it no longer meets the applicable FDA standards. The enforcement of the nation’s border and immigration laws is a national imperative, but there’s no “law and order” in pardoning a flagrant and unrepentant scofflaw merely because he was recklessly overzealous in prosecuting them. Those who fear the nationalization of the health-insurance industry because it will lead to the rationing of potentially life-saving care cannot at the same time insist that the state’s monopoly on lethal force should not be questioned outside of a courtroom.
Conservatism is not libertarianism. Conservatives have a noble suspicion of the instruments of state power, but they also recognize that those instruments are necessary, desirable, and meant to be judiciously wielded. The right’s intellectuals will probably never stop debating the maximally beneficial balance between these two conflicting values. Ted Cruz is channeling the voters for whom this debate is entirely academic. That may not be the road to a more thoughtful politics, but it sure is a path to victory.
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PODCAST: Can We Judge Kavanaugh Fairly?
Podcast: Kavanaugh and Rosenstein.
John Podhoretz 2018-09-24Can you take what we say about the nomination of Brett Kavanaugh seriously considering we’re conservatives and he’s a conservative? Are we defending him because we are genuinely discomfited by how insubstantial the allegations against him are, or are we doing so because we agree with him ideologically? We explore this on today’s podcast. Give a listen.
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But She Fights
A Trump of their own.
Noah Rothman 2018-09-21
There were many arguments for opposing Donald Trump’s bid for the presidency, but the retort usually boiled down to a single glib sentence: “But he fights.”
Donald Trump could accuse John McCain of bringing dishonor upon the country and George W. Bush of being complicit in the September 11th attacks. He could make racist or misogynistic comments and even call Republican primary voters “stupid”; none of it mattered. “We right-thinking people have tried dignity,” read one typical example of this period’s pro-Trump apologia. “And the results were always the same.”
If you can get over the moral bankruptcy and selective memory inherent in this posture, it has its own compelling logic. Driving an eighteen-wheel truck through the standards of decorum that govern political discourse is certainly liberating. If there is no threshold at which the means discredit the ends, then everything is permitted. That kind of freedom has bipartisan appeal.
Democrats who once lamented the death of decency at Trump’s hands were apparently only troubled by their party’s disparity in this new rhetorical arms race. The opposition party seems perfectly happy to see standards torn down so long as their side is doing the demolition.
This week, with passions surrounding Brett Kavanaugh’s nomination to the Supreme Court reaching a crescendo, Hawaii Senator Mazie Hirono demonstrated that Democrats, too, are easily seduced by emotionally gratifying partisan outbursts. “They’ve extended a finger,” Hirono said of how Judiciary Committee Republicans have behaved toward Dr. Christine Blasey Ford since she was revealed as the woman accusing Kavanaugh of sexual misconduct as a minor. “That’s how I look at it.”
That’s an odd way to characterize the committee chairman’s offers to allow Dr. Blasey Ford the opportunity to have her story told before Congress in whatever setting she felt most comfortable. Those offers ranged from a public hearing to a private hearing to a staff interview, either publicly or behind closed doors, to even arranging for staffers to interview her at her home in California. Hirono was not similarly enraged by the fact that it was her fellow Democrats who violated Blasey Ford’s confidentiality and leaked her name to the press, forcing her to go public. But the appeal of pugnacity for its own sake isn’t rooted in consistency.
Hirono went on to demonstrate her churlish bona fides in the manner that most satisfies voters who find unthinking animus compelling: rank bigotry.
“Guess who’s perpetuating all these kinds of actions? It’s the men in this country,” Hirono continued. “Just shut up and step up. Do the right thing.” The antagonistic generalization of an entire demographic group designed to exacerbate a sense of grievance among members of another demographic group is condemnable when it’s Trump doing the generalizing and exacerbating. In Hirono’s case, it occasioned a glamorous profile piece in the Washington Post.
Hirono was feted for achieving “hero” status on the left and for channeling “the anger of the party’s base.” Her style was described as “blunt” amid an exploration of her political maturation and background as the U.S. Senate’s only immigrant. “I’ve been fighting these fights for a—I was going to say f-ing long time,” Hirono told the Post. The senator added that, despite a lack of evidence or testimony from the accuser, she believes Blasey Ford’s account of the assault over Kavanaugh’s denials and previewed her intention to “make more attention-grabbing comments” soon. Presumably, those remarks will be more “attention-grabbing” than even rank misandry.
This is a perfect encapsulation of the appeal of the fighter. It isn’t what the fight achieves but the reaction it inspires that has the most allure. But those who confuse being provocative with being effective risk falling into a trap. Trump’s defenders did not mourn the standards of decency through which Trump punched a massive hole, but the alt-right and their noxious fellow travelers also came out of that breach. The left, too, has its share of violent, aggressively mendacious, and anti-intellectual elements. They’ve already taken advantage of reduced barriers to entry into legitimate national politics. Lowering them further only benefits charlatans, hucksters, and the maladjusted.
What’s more, the “fire in the belly,” as Hillary Clinton’s former press secretary Brian Fallon euphemistically describes Hirono’s chauvinistic agitation, is frequently counterproductive. Her comments channel the liberal id, but they don’t make Republicans more willing to compromise. What Donald Trump’s supporters call “telling it like it is” is often just being a jerk. No other Republican but Trump would have callously called into question Blasey Ford’s accounting of events, for example. Indeed, even the most reckless of Republicans have avoided questioning Blasey Ford’s recollection, but not Trump. He just says what’s in his gut, but his gut has made the Republican mission of confirming Kavanaugh to the Court before the start of its new term on October 1 that much more difficult. The number of times that Trump’s loose talk prevented Republicans from advancing the ball should give pause to those who believe power is the only factor that matters.
It’s unlikely that these appeals will reach those for whom provocation for provocation’s sake is a virtue. “But he fights” is not an argument. It’s a sentiment. Hirono’s bluster might not advance Democratic prospects, but it makes Brian Fallon feel like Democrats share his anxieties. And, for some, that’s all that matters. That tells you a lot about where the Democratic Party is today, and where the country will be in 2020.
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Politicians Need Free Speech Too
A lesson from Finland.
Sohrab Ahmari 2018-09-21
High-ranking politicians are entitled to freedom of speech and conscience. That shouldn’t be a controversial statement, but it often is, especially in European countries where the range of acceptable views is narrow–and narrowing. Just ask Finnish Foreign Minister Timo Soini, who spent the summer fighting off an investigation into his participation at an anti-abortion vigil in Canada. On Friday, Soini survived a no-confidence vote in Parliament over the issue.
“In general, I’m worried that Christianity is being squeezed,” he told me in a phone interview Friday, hours after his colleagues voted 100 to 60 to allow him to keep his post. “There is a tendency to squeeze Christianity out of the public square.”
Soini had long been associated with the anti-immigration, Euroskeptic Finns Party, though last year he defected and formed a new conservative group, known as Blue Reform. Before coming to power, Soini could sometimes be heard railing against “market liberals” and “NATO hawks.” But when I interviewed him in Helsinki in 2015, soon after he was appointed foreign minister, he told me his country wouldn’t hesitate to join NATO if Russian aggression continued to escalate. He’s also a vociferous supporter of Israel.
Through all the shifts of ideology and fortune, one point has remained fixed in his worldview: Soini is a devout Catholic, having converted from Lutheranism as a young man in the 1980s, and he firmly believes in the dignity of human life from conception to natural death. “I have been in politics for many years,” he said. “Everyone knows my pro-life stance.” The trouble is that “many people want me to have my views only in private.”
Hence his ordeal of the past few months. It all began in May when Soini was in Ottawa for a meeting of the Arctic Council, of which Finland is a member. At the church he attended for Mass, he spotted a flyer for an anti-abortion vigil, to be held the following evening. He attended the vigil as a private citizen: “I wasn’t performing as a minister but in my personal capacity. This happened in my spare time.”
A colleague posted a photo of the event on his private Twitter page, however, which is how local media in Finland got wind of his presence at the rally. The complaints soon poured into the office of the chancellor of justice, who supervises the legal conduct of government ministers. A four-month investigation followed. Soini didn’t break any laws, the chancellor concluded, but he should have been more circumspect when abroad, even in his spare time.
Soini wasn’t entirely oblivious to the fact that he was treading on sensitive ground. A top diplomat can never quite operate like a private citizen, much as a private citizen can’t act like a diplomat (someone tell John Kerry). Still, does anyone imagine that Soini would land in such hot water if he had attended a vigil for action on climate change? Or one in favor of abortion rights?
“No, no, no. I wouldn’t say so … The Finnish official line is that I should be careful because abortion is legal in Finland and Canada.” So the outrage is issue-specific and, to be precise, worldview-specific. In Nordic countries, especially, the political culture is consensus-based to a fault, and the consensus is that the outcome of the 1960s sexual revolution will never be up for debate. Next door in Sweden, midwives are blacklisted from the profession for espousing anti-abortion views. Ditto for Norwegian doctors who refuse to dispense IUDs and abortifacients on conscience grounds.
The consensus expects ministers to bring their views into line or keep their mouths shut. “This is of course clearly politics,” Soini told me. “I think I have freedom of conscience. I haven’t done anything wrong. This is me practicing my religion.” And the free exercise of religion means having the right to espouse the moral teachings of one’s faith—or it means nothing.
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Planet Earth Dodges a Bullet
Banality and evil.
JOHN STEELE GORDON 2018-09-20
A week ago, I wondered what was going on in Sunspot, New Mexico. The FBI had swept into this mountain-top solar observatory, complete with Black Hawk helicopters, evacuated everyone, and closed the place down with no explanation whatever. Local police were politely told to butt out. It was like the first scene in a 1950’s Hollywood sci-fi movie, probably starring Walter Pidgeon.
Well, now we know, at least according to the New York Post.
If you’re hoping for little green men saying, “Take me to your leader,” you’re in for a disappointment. It seems the observatory head had discovered a laptop with child pornography on it that belonged to the janitor. The janitor then made veiled threats and in came the Black Hawks.
In sum, an all-too-earthly explanation with a little law-enforcement overkill thrown in.
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