The Health Care Shell Game: Why Not Leave Policy to the States?

In my latest blog post for Learn Liberty, I take on arguments against decentralizing health care policy to the states on the grounds of fiscal capacity: So if federal ACA spending were cut or even zeroed out, why couldn’t states that like the legislation simply reinstate the same taxes and spending that the federal government …

Ideas have Consequences

There is a delightful piece in the New York Times on the reaction of the Harvard faculty to the reality of health care reform: For years, Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost. But those remedies will …

Organ Markets

The NYT editorial board is concerned about the shortage of kidneys for transplants. As one might expect, the most obvious solution to the problem is automatically dismissed: While some argue that the way to reduce the growing shortage is to pay living donors for kidneys, either in cash or government benefits, there are many ways …

The Costs of Creating a “Federally Facilitated Market”

Market failure is often cited as a justification for policy intervention. However, one always faces the possibility that the costs of government failure may be greater than the costs of market failure. In the end, there must be a weighing of the costs and the benefits of policy. We witnessed a great example of government …

Quote of the Day

Today we go back into the archives to find a quote that is every bit as timely today as it was when first issued. We will also play a game: name the author. The rules are simple. If you can identify the source, feel free to add it to the comments (no cheating). I know …

The Empirical Record

  The Census Bureau is changing its annual survey, making it difficult to measure the impact of the Affordable Care Act. As the NYT reports:   An internal Census Bureau document said that the new questionnaire included a ‘total revision to health insurance questions” and, in a test last year, produced lower estimates of the …

Extensions

For those who failed to sign up for Obamacare, the administration has provided a list of 17 ways you can get an extension. Apparently the extensions will be granted on the honor system (check a box, and we will trust you). If none of the justifications for extensions apply, you may only have to wait …

Keep and Fix

Jonathan Chait has an interesting piece on the “keep and fix” solution for Obamacare (New York Magazine).  One of the more interesting points: the parts of the Affordable Care Act that people like the most are also the parts that are least widely recognized as being part of Obamacare. Example: 81 percent have a favorable …

Any Surprises?

With midterm elections approaching, the White House has again delayed some of the more unpopular portions of the Affordable Care Act. As the NYT reports, the announced delays go much further than the earlier reprieves, “essentially stalling for two more years one of the central tenets of the much-debated law, which was supposed to eliminate …

Once Again, We Chase the Shiny Objects

This week the Congressional Budget Office released The Budget and Economic Outlook: 2014-2024. From the press coverage, one would have guessed the report was either entitled Obamacare: the Job Killer that is Almost as Bad as Benghazi or Obamacare: Ending the “Job Lock” and Opening the Door to Leisure. In reality, the impact of the …

Another Horror Story from Britain’s NHS

My wife works in cancer support, and she told me this evening about a case of a British woman who wrote into one of the online groups with which she works. She had had limb salvage surgery for bone cancer, replacing her humerus with a titanium prosthetic bone (my wife had the same type of …

Social Norms as Market Regulation: The Case of Pre-PPACA Nongroup Health Insurance

The debate over pre-PPACA (Obamacare) nongroup health insurance has heated up again recently, particularly on the issue of rescissions (cancellations of policies). John Goodman claims that before the PPACA, rescissions almost never happened except in cases of fraud. Nevertheless, one problem with the nongroup market in many states was denial of applications for coverage from …

Making Things Work

Whether one looks to the domestic or the international arena, it appears that little is working these days. Three issues I have been following: 1. The Affordable Care Act (formerly known as Obamacare): The difficulties in the ACA roll out persist and the circular firing squad continues to take aim at the guilty parties. Megan McArdle …

HealthCare.gov and Implementation Problems

Public policies can fail for a host of reasons. For example, policymakers may fail to understand the causality underlying the problems they wish to address or employ the wrong policy instruments. They may fail to understand the unintended consequences of policy or some of the critical trade-offs. They may design policies that will only succeed …

Other Californians Facing Health Law Sticker Shock

Not just my brother. From SFGate: They have been paying $7,200 a year for a bare-bones Kaiser Permanente health plan with a $5,000 per person annual deductible. "Kaiser told us the plan does not comply with Obamacare and the substitute will cost more than twice as much," about $15,000 per year, she says. This new …

My Brother’s Obamacare Experience

My brother is individually insured in California. Here's what's he says about what will happen to his insurance plan: More details on my forced insurance changes for 2014 (this is the complete summary provided by my insurer - I'm not cherry picking details): Premiums: same. Deductible: $3K -> 5K. Doctor copay: $40->60. Specialist copay: $40->70. …

The Ted Cruz Shutdown Is Looking like the Charge of the Light Brigade

Apparently, if anyone can make Americans love Obamacare, it's Ted Cruz. What? Just look at the polls. There are brutal numbers for the GOP in a new Fox News poll, confirming numbers from an earlier Quinnipiac poll. Obama's job approval is up, support for Obamacare is up (opposition running at just 47-45 in the Q …

Defunding Obamacare: In Search of a Strategy

As we all know, if a continuing resolution (or CR) is not passed by the end of the day on September 30, the government will shut down. Senator Ted Cruz (R-TX) has threatened to filibuster the House CR because if debate is suspended, the provisions defunding Obamacare will be eliminated via majority vote. If Senator …

Time for a Speech on the Affordable Care Act?

On Tuesday, President Obama devoted 16 minutes to making the case for some unspecified action in Syria under conditions yet to be determined. After seeing the new CNN/ORC poll, one wonders whether it is time for a speech on the merits of the Affordable Care Act.  According to the poll (conducted September 6-8), 6 percent …

Congress and the Affordable Care Act: File under Revealed Preferences

John Bresnahan and Jake Sherman (Politico) report (unsurprisingly) that those who brought us the Affordable Care Act are scurrying to create exemptions for Capitol Hill. The big concern: the costs of insurance on the exchanges will lead to the rapid exodus of legislative aides—a policy-induced brain drain. The talks — which involve Senate Majority Leader …

Hundreds of Unnecessary Deaths in One NHS Hospital

A new public inquiry into abuses at the Mid Staffordshire National Health Service Trust's hospital has found a years-long pattern of fatal mistakes and abuses. The report makes for damning reading. From the BBC report: Years of abuse and neglect at the hospital led to the unnecessary deaths of hundreds of patients. But inquiry chairman, …

Occupational Licensing as an Implicit Barrier to High Skill Migration

That's the subtitle of a new working paper from Peterson, Pandya, and Leblang. Here's the abstract: Skills are often occupation-specific, a fact missing from existing research on the political economy of immigration. Although analyses of survey data suggest broad support for skilled migration occupational licensing regulations persist as formidable barriers to skilled migrants’ labor market …

When Obamacare Really Kicks In

Most of the PPACA's most controversial provisions were backloaded until after this election. Unless Romney wins the presidency and Republicans at least make it close enough in the Senate that they can pick off a moderate Democrat or two on a roll-call, these provisions will start to kick in next year. Avik Roy explains: In …

Market Seems to Believe Romney Would Repeal Obamacare if Elected

...Judging from the the post-debate health care stocks performance. Of course, the assumption would have to be that the GOP both retains the House and takes the Senate, also unlikely. Context: I've had debates with people who say that Romney would quickly go back on that promise once elected, but I just don't see it. …

Some Bad Arguments for the PPACA from Jonathan Gruber

Even though I disagree with much of its interpretation, I admire Jonathan Gruber's pre-PPACA research on health insurance markets. He's one of the most forthright and clear-headed advocates of government takeover of health insurance that I know. However, his recent defense of the law in The New Republic indulges some pretty blatant economic fallacies: But …

The Necessary Inadequacy of Charity

A common libertarian and conservative response to questions about how beneficiaries of government programs will carry on after the removal of their subsidies is that charity should take care of them. This answer is often overly glib, even when combined with the observation that a lower burden of taxation might foster more giving (charity is …

Munger on Single-Payer

Mike Munger, Duke political scientist and sometime Libertarian Party of North Carolina gubernatorial candidate, explains his support for single-payer health insurance: I would prefer personal responsibility, and a competitive market in health care. Modeled after the very successful, constantly cheaper, constantly better quality, service in Lasik surgery and other "elective" surgeries. If someone, anyone, would …

Was this a victory for universal coverage?

First, for most Americans the amount due will be far less than the price of insurance, and, by statute, it can never be more. It may often be a reasonable financial decision to make the payment rather than purchase insurance . . . Indeed, it is estimated that four million people each year will choose …

Obamacare Upheld: Thank Goodness!

The Supreme Court's decision to uphold the Affordable Care Act (don't call it "Obamacare"!) gives me a great sigh of relief. Although I was one of those who thought it well-nigh impossible to be overturned when the lawsuits were initially filed, over the last several months I began to think that there was actually a …

Ed Glaeser on Federal Mandates

Harvard economist Ed Glaeser weighs in on federal mandates in general: Although I am open to having state governments require more health coverage, I fear a federal government with too much power to control individual behavior. The track record of federal interventions in managing markets suggests a strong case for limiting that power. The question …

The Affordable Care Act and the Power of Meh!

Policy wonks and pundits are waiting in anticipation for tomorrow’s decision on the Affordable Care Act (I know it was one of the first things that crossed my mind this morning as I prepared for the day).  Although social scientists may not be too good at making predictions, I think most of us could  have …

A Health Insurance Mandate Libertarians Can Support

Libertarians have generally opposed government mandates to participate in commerce on moral, economic, and constitutional grounds. Certainly, a federal government mandate to buy private health insurance contradicts standard libertarian understandings of the right to property and self-determination and the ability of individuals to decide for themselves their need for insurance (and concomitant skepticism of paternalist …

Indian Superbugs

As a followup on my libertarian case for prescription laws, I note this recent story on Indian superbugs that are totally antibiotic-resistant: India’s $12.4 billion pharmaceutical industry manufactures almost a third of the world’s antibiotics, and people use them so liberally that relatively benign and beneficial bacteria are becoming drug immune in a pool of …

When X is Not-X

There have been some wonderful pieces written in the past few weeks trying to make sense of the President’s claim that a SCOTUS decision to overturn the Affordable Care Act would be unprecedented. Of course, the pieces often proceed as follows The President stated X The President obviously knows not-X  Therefore X must have a …

In the Land of the Blind, the One Eyed Man is King

Those of you who followed Grover’s link and read the transcript (or even better, heard the audio) of yesterday’s Supreme Court hearing may find the following quote entertaining (h/t Politico). The Source: White House Counsel Kathryn Ruemmler. “Mr. Verrilli is an extraordinarily talented advocate who possesses a sharp mind, keen judgment, and unquestionable integrity. He …

Less Economic Freedom, Less Personal Freedom

This proposal in the UK to tax "fatties" highlights once again how once government gets deeply involved in funding health care, the pressures to control people's lifestyles become significant. This is the same argument we hear from supporters of sky-high cigarette taxes, smoking bans, seat-belt and helmet laws, ad nauseam. "We all pay for it." …

Chart of the Day

My only problem with the chart is its title. I don't think a simple bivariate correlation is enough to establish causality. But it's a suggestive piece of evidence, since both regime uncertainty and the employer mandate associated with the PPACA are plausibly related to slowing job growth.

Liberty: the example of circumcision

The Seattle Times, Slate, and other outlets have run interesting stories in the last couple of days discussing a new initiative that will appear on this November's ballot in San Francisco--and hold onto your privates, gentlemen: It would ban circumcision for all minors (under age 18), rendering it a misdemeanor punishable by up to one …

The Care of the Elderly Under Socialism

 European commentators on US healthcare are often misguided in their description of the American system as a ‘free market’ model - when that system involves significant levels of government regulation and funding. Equally, American commentators are often misguided in their accounts of ‘socialist’ healthcare in Europe. Europe contains a diversity of healthcare systems. Some, such …

Additional Thoughts on Health Care: Eliminate the “Backstops”

Having read Judge Vinson’s decision, available here, I must recommend it. It is a relatively brief 78 pages and, at times, the discussion is quite lively. Will the Supremes agree with Vinson on the unconstitutionality of the individual mandate and the question of severability? Only time will tell. One passage (not central to the decision) …