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
Must-Reads from Magazine
A Bias in Favor of Bias
Selectivity in the social sciences.
Jonathan Marks 2018-06-14
Last year, I criticized universities for hurrying to implement programs to combat microaggressions, “mostly subtle, mostly inadvertent slights directed at racial minorities and other ‘marginalized” groups.’” According to a review of the research conducted by Scott Lilienfeld, professor of psychology at Emory University, there was little, if any, evidence that such programs do more good than harm. Universities, which should pride themselves on following the evidence wherever it leads, seemed to have succumbed to the pressure to “do something” about racism.
One might imagine that this phenomenon is limited to administrators and faculty who don’t understand what the science says. Alas, scientists have proven little better than non-scientists at weighing the evidence, when it comes to politically charged topics like race and gender bias.
For those who want to know more about this problem, I recommend Lee Jussim’s blog, Rabble Rouser. One could accuse Jussim, a professor of psychology at Rutgers University, of prejudice in favor of rabble-rousing, particularly concerning left-wing bias in the sciences. However, he and his colleagues recently provided the first empirical support for a proposition widely believed by psychologists, which holds that inaccurate stereotypes can have a cumulative effect far greater than what we can see in “dyadic” studies involving one perceiver and one perceived.
It is conventional political wisdom on the left that, for example, when teachers inaccurately claim that women are less equipped to excel in college than men, women will underperform as a result. This effect is believed to be observable across a variety of inaccurate stereotypes, particularly about race and sex. It may have been just like rabble rouser Jussim to notice that a widely held left-affirming view lacks empirical support. But it is also just like Jussim to investigate and let the chips fall where they may, or, again, to follow the evidence wherever it leads.
Following the evidence wherever it leads may be damaging to the conventional wisdom that women scientists suffer widely from “implicit bias” when it comes to their prospects for career advancement. There is certainly some evidence for this proposition. A well-known study that presented participants with identical applications for a lab manager position, with only the gender of the applicant varying, found that participants “rated the male applicant as significantly more competent and hirable than the (identical) female applicant. These participants also selected a higher starting salary and offered more career mentoring to the male applicant.” There is also evidence from multiple studies, finding bias in favor of women.
As Jussim points out, scientists who cite the first study and fail to acknowledge the existence of the others seem to be biased in favor of the thesis that bias explains disparate outcomes. The American Association for the Advancement of Science (AAAS) held a conference in 2016 in which “presentation after presentation by famous, influential, and prestigious scientists argued for the power and prevalence of implicit gender biases in peer review,” the vetting of a scientist’s grant proposals and paper submissions by other scientists. But “not a shred of evidence of implicit bias in peer review was actually presented” at the conference.
Jussim doesn’t claim that no such evidence exists. But he is distressed that distinguished scientists were presenting as settled science the implicit bias explanation for differences in professional outcomes, even though the evidence for that explanation is, at best, quite mixed. He pointed us to a recent series of studies in which five different political science journals looked for evidence of bias in their peer review processes. Even though “the journals differ in terms of substantive focus, management/ownership, as well [as] editorial structure and process, none found evidence of systematic gender bias in editorial decisions.”
The only bias the speakers at the AAAS demonstrate here is “bias in favor of bias.” Jussim concluded that “this sort of thing is commonplace, when scientists allow their political agendas to drive their claims about science.” This conclusion does not imply that all claims regarding the influence of bias in higher education are false or, more broadly, that the scientific method doesn’t work. It does suggest that scientists who are adept at exposing the foolishness of non-scientists need to attend more closely to their own.
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The Party of Trump, If You Can Keep It
Will the reverence Trump inspires outlast his presidency?
Noah Rothman 2018-06-14
Approximately once every quarter for the last two years, we’ve been bombarded by declarations that Donald Trump’s takeover of the GOP is complete. The frequency with which the verdict is rendered would suggest the thesis is flawed.
Trump’s takeover of the GOP was complete after he secured the party’s presidential nomination, but it was also complete after he won the presidency. It wasn’t Trump’s GOP until his first address to a joint session of Congress, or maybe when threw congressional Republicans under the bus to accept a deal offered by “Chuck and Nancy,” or when Trump-skeptical Senators Jeff Flake and Bob Corker ran for the exit. Most recently, this week’s primary contests in South Carolina and Virginia indicate that, at long last, the GOP’s resistance to Trump is in its death throes.
Trump’s “takeover” of the GOP requires constant affirmation because the president is still regarded with suspicion by some of his party’s most prominent federal and state-level elected officials. Of course, Trump as both the president and the titular head of his party commands the fealty of the party’s base voters, its enforcers in media, and elected officials who do not dare offend the party’s core constituents. For them, the “Trump’s takeover of the GOP” theme needs repeating because the condition might be uniquely ephemeral.
Trump’s occasional clashes with Republican lawmakers receive levels of attention disproportionate to their relevance because Trump himself and his followers elevate those conflicts into dramatic contests. It is a satisfying opportunity to relive 2016—a protracted battle Trump and his acolytes decisively won. But those fights are rarely about policy. They are usually about personality.
For example, why did Rep. Mark Sanford lose his primary fight? The Beltway analysis holds it was his frequent criticisms of Trump that did him in. And while there were certainly other issues in the campaign (Sanford lost the support of his state’s Republican establishment and took hits for failing to spend sufficiently on infrastructure as governor), his opponent successfully transformed the race into which of the two loved Trump more. Sanford’s sins consisted of scolding the president for defending white nationalists in Charlottesville and promising to pay the legal fees for his most violent supporters. Policy disagreements took a back seat.
Sanford’s loss came as a surprise to the Freedom Caucus, of which he is a member in good standing. This conservative body of lawmakers, many of whom are staunchly supportive of the president and serve as a bulwark in defense of his agenda in the House, has been critical of Trump’s decision to register his opposition to Sanford on Election Day just in time to get some credit for his loss. Their consternation is understandable. The Freedom Caucus has served as the vanguard for Trump. They have held firm to a hardline approach to immigration, and they are leading the effort to force the Justice Department to disclose information related to its ongoing investigations into Trump and his associates. But Donald Trump cannot suffer personal effrontery, and so one of the Caucus’s leading members had to go.
In Virginia, a truly noxious candidate has managed to secure the Republican nomination to face Senator Tim Kaine in the fall. A transplant from the Upper Midwest, Corey Stewart has leaned heavily into his adopted Southern roots and sought out some questionable associations. He’s draped himself in the Confederate flag, compared the removal of Confederate statuary with the actions of ISIS, associated himself with the “alt-right,” accused Democrats of forging Barack Obama’s birth certificate, and openly supported the virulent anti-Semite and failed congressional candidate Paul Nehlen. Virginia’s Republican figures have attacked Stewart, and the GOP’s Senate committee has withheld its endorsement.
Stewart is playing the part he thinks is most effective in the age of Trump. In 2015, Stewart was, like every other Republican ladder-climber, touting his “relationship with minority voters” because that’s what the 2012 “autopsy” recommended. “That’s what Republicans need to do in order to continue to win elections in Northern Virginia,” he added. Trump demonstrated that there was another path to victory. Barring a miracle, Corey Stewart will not be the next U.S. Senator from Virginia. The satisfaction Republican voters might derive from nominating this flawed candidate is roughly equivalent to screaming into a pillow; a cathartic but fleeting thumb in the eye of “elites.” Stewart and his like will have as lasting an impact on the history of the republic as Todd Akin or Sharron Angle.
Of course, Tuesday’s election results suggest that the GOP is the Party of Trump. They also indicate that the Party of Trump is hard to define beyond association with the man himself. That is due, in part, to the fact that Trump’s policy preferences and ideological affinities are fluid. Six months ago, if you weren’t defending the president’s threat to rain down “fire and fury” on North Korea, you were a spineless appeaser. Today, if aren’t supportive of Trump’s obsequious praise for the murderous dictator, you’re a blood-soaked warmonger. Trump promised to punish China for its trade practices and currency manipulation, only to selectively abandon those positions. Where Trump stands on NATO, NAFTA, ObamaCare, Russia, Syria, the G-7, DACA, the export-import bank, and a whole range of issues depends on which side of the bed he got up on that morning.
The North Star by which voters can gauge fealty to Trump is the extent to which Republicans defer to him personally. That’s why, as Sen. Corker said, something approaching a cult of personality has sprung up around the president. Voters simply do not have consistent policies and ideological affinities to help them navigate a complex and confusing political environment. The powerful desire to enforce group solidarity around Trump is creating the appearance of homogeneity, but it’s cosmetic. That’s why we are privy to regular assertions that the GOP is Trump’s party now. It requires repetition because it is not self-evident.
Yes, the Republican Party is the party of Trump. But the centrifugal pull associated with the principle and ideology toward which Trump was and remains hostile continues to pull on the Republicans whose political maturation predated Trump’s inauguration. A fair reading of the political environment must concede it is still unclear which of these two competing forces will win out in the end.
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Fossil Fools
Fanaticism.
Noah Rothman 2018-06-13
Over the weekend, the Democratic National Committee voted in favor of refusing all future donations from fossil-fuel companies. They’re so proud of the decision that it was only publicized on Tuesday, and then only by reporters who had to do some digging to learn the news.
The resolution will bar the national committee from taking any donation tied to corporate political-action committees linked to coal, oil, or gas companies. Marveling over the news, ThinkProgress quoted a variety of progressive activists who are thrilled that the DNC has finally lived up to the spirit of the Democratic Party’s platform. That platform, if you’ve never read it, calls for the elimination of tax incentives and subsidies for fossil-fuel producers, demands a “phase down” of the development and extraction of new sources of carbon fuel, and calls on the Justice Department to investigate them for misleading the public on “scientific reality of climate change.” Absent from ThinkProgress’s account of this wondrous turn of events, however, is any comment from the DNC.
The Democrats’ reluctance to trumpet their righteous decision to decline donations from the fossil-fuel industry—a sector of the economy that employed 7 million people and made up 5 percent of U.S. GDP in 2017—is, perhaps, understandable. According to ThinkProgress, the Democratic Party’s hostility toward fossil-fuel producers is so intense that 90 percent of the industry’s political donations go to the Republican Party as it is. In that sense, every time a Democrat fills up her car or takes a flight, she’s contributing to Republican candidates or causes. Hypocrisy is, after all, the tribute vice pays to virtue. Today, that tribute amounts to $2.91-per-gallon.
Maybe the most bizarre aspect of this fanatic fealty to the tenets of green absolutism is that the Democrats could make a salient point about clean energy and market economics without branding the entire fossil-fuel enterprise a bête noire. The coal industry is in decline, and it has been for years. In the last 15 years, coal has declined as a share of the energy market by one-third. Oil, too, has declined slightly after a marginal resurgence. In the same period, renewable energy sources have increased from 5 to 10 percent of the market as the costs of production have declined, but every source of energy pales in comparison to natural gas. Revolutionary new technologies like hydraulic fracturing have made gas cheap and ubiquitous, to the point now that, for the first time since 1953, the United States is projected to become a net-energy exporter by 2022.
Not only does that mean that the U.S. will benefit from a kind of energy security that seemed like a fantasy just a decade ago, it means that America can relieve the energy burden on its allies, which are dependent upon exports from states like Russia and China. Even if national and economic security arguments don’t move climate fanatics, the environmental benefits of America’s transition to reliance on natural gas should. Burning natural gas emits about 50 percent less carbon into the atmosphere than coal, and the shift to natural gas has contributed to the precipitous decline of carbon emissions released into the atmosphere over the last decade in the West.
Of course, the left’s environmentalist wing doesn’t want to hear any of this. They’d prefer to hear how fossil fuels could be relegated to history’s dustbin by force of will alone. They want Democrats to treat this vital sector of the economy like apartheid South Africa. With the DNC’s vote, it would seem like the Democratic Party agrees with its left wing on the immorality of supporting in any form fossil fuel production and exploration. It makes you wonder, then, why Democrats don’t seem to want to talk about it.
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Canada Comes to Its Senses on Iran
Iran's isolation won't be reversed.
Sohrab Ahmari 2018-06-13
I have never been mistaken for a fan of Justin Trudeau, nor will I ever be so mistaken. On the whole, I agree with Ben Shapiro’s assessment of the Canadian prime minister (“Justin Trudeau is what would happen if the song ‘Imagine’ took human form…”). Trudeau’s commitment to full-spectrum progressivism, combined with his vanity and moral preening, make him one of the least serious figures ever to lead a major Western power. Even so, I found myself cheering Trudeau’s Liberal government on Wednesday after it backed a resolution in the House of Commons to “immediately cease any and all negotiations or discussions” with the Iranian regime.
The resolution also designated the Islamic Revolutionary Guard Corps as a terrorist entity under Canadian criminal law, condemned the mullahs for their “ongoing sponsorship of terrorism around the world,” and denounced Supreme Leader Ali Khamenei for “calling for genocide against the Jewish people.”
Liberal support for the resolution marked a striking about-face. Trudeau had campaigned for restoring Ottowa’s ties with Tehran, severed in 2012 by the previous, Conservative government. “I would hope that Canada would be able to reopen its mission” in Tehran, Trudeau told an interviewer in June 2015, just as Barack Obama was concluding his nuclear diplomacy with the mullahs. “I’m fairly certain that there are ways to re-engage.”
It turns out that even Trudeau-led Canadian Liberals have their limits when it comes to dealing with the Islamic Republic. As the Canadian broadcaster CBC reported, Ottawa dispatched two diplomatic missions in 2017 to explore a rapprochement. But there were two stumbling blocks. The Iranians insisted that Tehran should be removed from Canada’s list of terror-sponsoring nations, and the Canadians were determined to free various hostages held by the regime. The Iranians were apparently immovable on the matter of the hostages–that’s how they roll–and the Canadians were, in turn, unwilling to deny the basic truth about Iran’s role in sponsoring international terror.
Passage of the resolution doesn’t mean Canada is rethinking its support for Obama’s nuclear deal. But it underscores Iran’s growing isolation, as a new generation of Western leaders comes to learn that there are no “moderates” and “hard-liners” in Tehran–only tyrants and terrorists.
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PODCAST: Un Singular Sensation
Podcast: How bad was it?
John Podhoretz 2018-06-13Was the Singapore Summit nothing, or bad, or the worst thing ever? This is the question we debate. We also examine the meaning of the primary defeat of Republican anti-Trumper Mark Sanford and what this portends for the GOP. Give a listen.
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