Things We Read Today (23), Wednesday

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Healthcare from Sea to Shining Sea

Via Ted Nesi’s Twitter feed comes an interesting article by Michael Lind proposing, as the solution to the United States’ health care problems, well, centralized command-economy-style price controls:

Although the problem they address is real, these New York Times essays ignore the most important cause of America’s health care cost inflation—the overcharging of non-elderly Americans, by physicians, hospitals and drug companies, for routine medical goods and services that are much cheaper in every other country.  In addition to ignoring the major problem, the two authors fail to mention the necessary solution—price controls imposed by government on America’s grossly overcompensated medical providers.

The first argument against such thinking, of course, is embedded within the phrase “non-elderly Americans.”  As is the case when unsigned editorials call for “Medicare for all,” Lind is essentially proposing the cause of the problem he decries as the bigger solution.  It is because Medicare is such a huge price-control factor at the elderly end of the market that service providers find it necessary to raise prices on everybody else.  It’s Laurel and Hardy on a waterbed.

Price controls seek to apply an arbitrary cap on economic activity without addressing the underlying issues.  Simplified, there is some abstract value that doctors wish to receive for their years of training and high-pressure workdays.  Telling them that they cannot collect enough in fees to achieve that value will have unintended consequences.  The giveaway of Lind’s flawed thinking comes in this sentence:

In part [the high feeds of primary care doctors are] because of a shortage of primary care physicians in the U.S., where doctors prefer to reap even more outsized incomes as specialists.

Cap the fees of specialists, and every specialist won’t switch to primary care (especially if you cap fees for that, as well, which appears to be the intention).  You’ll end up with fewer doctors altogether.  And you’ll end up with less innovation, which enters the discussion here:

Budget projections are easily rendered quaint by radical cost savings from technological innovation, for example.  Budget experts in the 1960s, failing to foresee Lasik surgery technology, might have predicted that widespread eye surgery for Americans would have bankrupted the U.S.

High prices are actually an incentive for investment in just such innovations.  The high cost of old fashioned methods suggest that innovators can reap outsized rewards when their investments first pay off (partly paying for the cost of dead ends), at least initially, until the innovation becomes standard.

And all of this — the fees, the specialties, the technology, the innovation, the investment — points to the real jaw-dropper in Lind’s argument:

The solution to the problem of excessive medical prices and bloated medical industry profits is the tried and tested solution adopted by all other advanced economies, including nations with pro-market, anti-statist traditions like those of the U.S., such as Switzerland: government regulation of what doctors, hospitals and pharma companies are allowed to charge.

In economics, prices are the means of allocating scarce resources throughout a complicated system.  With the United States innovating and allowing people to become high-end specialists (not to mention covering the cost of things like global security), there’s a little bit of running room for Switzerland’s board of price controllers to try their hand at health-industry omniscience.  In any other context but the muddied waters of American health care, it would be utterly laughable to compare the continent-spanning U.S. with a European country that’s roughly equivalent to a slightly more populated South Carolina.

 Something to Remember on Polling

There isn’t much by way of encouraging news for Republicans in WPRI’s recent poll, touching on the Congress and Senate races.  But flagging campaign staffs on either side of the aisle might find a sort of encouraging goal in the last two paragraphs of this Howie Carr column:

“Democrat Martha Coakley … enjoys a solid, 15-percentage-point lead over Republican rival Scott Brown as the race for U.S. Senate enters the homestretch, according to a new Boston Globe poll of likely voters. … Coakley’s lead grows to 17 points — 53 to 36 — when undecideds leaning toward a candidate are included in the tally.”

Nine days later, Scott Brown won, 53-47. Anyone know what channel C-SPAN is on in Brighton?

The Head-Rattling Echo Chamber

While I’m stepping beyond my policy scope, here, and looking at politics, the post-debate clip of the night has to be Chris Matthews’s “we’ve got out the knives” rant, encouraging President Obama to watch MSNBC more for ammunition.

Matthews’s broader advice — he runs on with a litany of arrows that his network has whittled, but that Obama didn’t shoot — is an archetypal example of echo-chamber thinking.  For one thing, you’d better believe that Mitt Romney had prepared answers offering context to all of MSNBC’s attacks and would have made the president seem petty and divisive for bringing them up in a live debate.

More importantly, though, Matthews apparently believes that things like the 47% statement   are unanswerable affronts.  They’re not.  In fact, very few things are, so if you ever find yourself thinking that all you have to do is make some tidbit known and the world will change, you might need to reevaluate.  Explanation is always necessary, and it always gives the other side opportunity for response (weak as it may be).

But I’d Sure Like Answers to This

So, the first excuse for U.S. nonfeasance in preparing for the attack of the U.S. embassy in Benghazi, Libya, was a silly YouTube video, and the storyline culminated in a photo that left many Americans wondering what country they were in.  Now, we’re getting excuse number two:

Small teams of special operations forces arrived at American embassies throughout North Africa in the months before militants launched the fiery attack that killed the U.S. ambassador in Libya. The soldiers’ mission: set up a network that could quickly strike a terrorist target or rescue a hostage. …

The counterterror effort indicates that the administration has been worried for some time about a growing threat posed by al-Qaida and its offshoots in North Africa. But officials say the military organization was too new to respond to the attack in Benghazi, where the administration now believes armed al-Qaida-linked militants surrounded the lightly guarded U.S. compound, set it on fire and killed Ambassador Chris Stevens and three other Americans.

The message is supposed to be that the Obama administration was on the ball, so the buck should be passed to some special-ops division that didn’t get its act together quickly enough.  Understandably, the facts are sparse, as yet, but this looks like pretty thin cover.  Most notably, you don’t need an established network (which certainly takes time) in order to respond to immediate, identified threats.

Digging more deeply into the Wednesday Providence Journal provides a perfect contrast, in an excellent column by Mark Patinkin, describing how he avoided being kidnapped when reporting on Beirut, Lebanon, in 1986:

… I did hundreds of hours in safety planning. I learned which hotels Westerners booked and made a note to stay away from them. Then I flew to Virginia to a global security firm. They warned that if I got in trouble, there was no 911 for anyone to call, so it was all on me. Their advice: If someone ordered me into a car at gunpoint, run, and if I was killed, so be it. Then they made me a bullet-proof vest sewn into a blue-jean jacket so it wouldn’t stand out.

The United States government, one hopes, has the sorts of agents whom Patinkin would have sought for advice already on the staff and, well, prepared.  The important distinction to remember is that there’s long-term planning to address a turbulent situation over time, and then there are short-term precautions, and then there are emergency actions.  A nation that can send an overwhelming military force to another region within months and send unmanned drones on assassination missions has to be able to defend and rescue its diplomats in hostile regions on a moment’s notice.

After all, the fellow who made the video that constituted excuse #1 was identified and brought in for questioning within days.



  • PeteB

    I predict that the Libyan attack was masterminded by a high ranking ex army officer using ex army commando's as pay back for our role in the down fall of Kadaffi.

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