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August 27, 2007

Dangerous, Rather Than Annoying, Arguments

Folks konw I think McMegan is an interesting writer. Some of you even hold it against me. But just this once, you can't stop e-mailing to tell me she wrote a really, really long post on health care. I know! I read it! It's very bad!

It relies on unproven and incorrect premises ("Most advocates of single payer, I think, care most about this justice claim. They may also think that they can make the system more efficient, but if one could somehow prove scientifically that a private system would be cheaper and better, they would still favor a public system as long as a substantial population remained uninsured); brackets the argument about efficiency then pretends it doesn't figure into reformer's claims; radically overstates individual culpability for illnesses; elides the fact that living a healthier life just means you die from something expensive later; mistakes an intergenerational compact (wherein each generation pays for the next, rather than making a one-time transfer) for charity; and appears to miss the fact that Medicare already exists, and so single-payer would not mean more resources would be transferred to the old, thus obviating the central point. And that's just a partial list!

But this is the type of bad I can get behind. McMegan's post is one I disagree with, but do not fear. Indeed, if some eager speechwriter plugged it into Mitt Romney's next address ("My fellow Americans, I think it's time we abolished Medicare, because the old don't deserve our help. And we should also stop caring for the sick, because that colon cancer is your own damn fault Mr. I-Don't-Eat-My-Fiber.") I think we'd have found the straightest line between here and national health care.

Lately, though, I've been trying to think more systematically about which health care arguments are dangerous to reform, rather than just annoying to reformers. Here's what I've got so far:

  • The government can't do it. It'll be like the DMV. It's "socialized medicine." Do you love waiting times? etc.
  • It'll be too expensive.
  • Incrementalism-as-obstruction. i.e, "We should have a more "American" system based on tax credits and deductions!" These proposals don't have the downsides of real reform, but they don't fix anything, either. However, they do make it seem like the politician "has a plan." See Giuliani, Rudy.
  • National reform will fail, as it always has, and the cause will be dealt an enormous blow, just like in 1994. Better to be incremental and just cover kids or something.
  • It'll reduce pharmaceutical innovation.

Any more?

August 27, 2007 in Health Care | Permalink

Comments

Of course we hold it against you. McMegan isn't interesting, she's a bad person. She is a greed obsessed loon who is incapable of having a thought that does not entirely revolve around herself.

No, her argument doesn't need to be feared, but it should be hated. It represents a kind of unapologetic greed that is the closest thing to evil you're ever likely to see. She views the vulnerable in our society in the same way white supremacists do, as dead weight that we're better off without. That her views are are based on age and class do nothing to make them less repugnant. At least, not unless you're a upper class young man like Ezra Klein, in which case you can skip over entirely how ugly what she's saying really is.

Posted by: soullite | Aug 27, 2007 1:53:55 PM

I think just saying it will reduce "innovation" more broadly is a stronger argument. People dislike the Big Drug companies, but "medical technology" like better pacemakers and aeds are things people think are pretty good.

The GOP catch-all is "it will hurt the economy", followed by "taxy tax tax tax!"

But all of the ones you list are good arguments. The rejoinder to the DMV is obviously the VA ... but there aren't many good responses to the others.

Posted by: Nicholas Beaudrot | Aug 27, 2007 2:05:32 PM

"Someone ELSE will be choosing your medical care!!!!

This depends on the idea that you and your doctor choose it now, based solely on your best interest. But the specter of the government making a decision for you!!! seems to set people off. Don't know why having insurance companies make decisions for them doesn't hit the same chord, but I haven't seen it.

Posted by: Megan | Aug 27, 2007 2:08:47 PM

Am I the only one who's in and out of the DMV in less than 20 minutes every time I go? Maybe New York just got a lot more efficient than most states, but personally I think the "do you want something to become as slow and badly managed as the DMV" argument to be at least a decade past its prime.

Posted by: mad6798j | Aug 27, 2007 2:26:35 PM

Folks konw I think McMegan is an interesting writer. Some of you even hold it against me.

There's plenty of reasons we hold it against you. First, she's not an interesting writer - that is, she doesn't say anything that a bog-standard property-centric right-libertarian wouldn't be expected to say. Second, she writes almost exclusively on economics, but is actually astonishingly ignorant of economics; this makes her a rather bad and somewhat insulting example to hold up of bog-standard right-libertarian thinking. Third, she has a tendency to hold to the GOP line on a given issue long after any reasonable defenders have broken ranks; i.e., she's a party hack. Fourth, you know her socially, so linking to her over any number of other, smarter libertarians you don't hang out with makes your motives appear somewhat suspect - like you're promoting your pals instead of linking to the best people out there.

The reason I, at least, tend to harp on your linking/promotion of McArdle is that it's fairly different in character from the way you link to, say, Jonah Goldberg. Instead of an adversarial relationship - which is normal and healthy between ideological opponents - there's a cozy familiarity, and that leads to increased traffic and visibility for McArdle, and to the appearance that she's a reasonable, "acceptable" right-winger among lefty circles, which in turn makes her palatable to places like the Atlantic Monthly. So you and Yglesias end up promoting the career of yet another right-wing hack. I personally don't care how nice she is in person or how many cookies she's baked you; her political philosophy is stupid and vile, and in a media environment dominated by right-wing figures, we really don't need liberals going out of their way to help the careers of wannabe right-wing pundits. Here's a thought: why not try linking to professional commenters to your left for a while?

Posted by: Christmas | Aug 27, 2007 2:34:19 PM

Am I the only one who's in and out of the DMV in less than 20 minutes every time I go? - mad6798j

NJ used to be horrible. But they changed something, made a big deal out of changes being made, and suddenly anything at the DMV was super-duper quick. I can't figure it out. Nobody seemed to be working any harder before. There didn't seem to be any difference in the paperwork. There didn't seem to be more people.

Just all of the sudden things got better.

In FL, you don't need to go to the DMV for most things ... you can go to the Tax Assessor's office. E.g., getting an in-state license (when you have an out of state one) or registering your car is pretty darn quick.

Posted by: DAS | Aug 27, 2007 2:46:43 PM

um, she doesn’t say efficiency “doesn’t figure into reformer’s claims,” but rather suggests that it is secondary to the justice claim.

i don’t understand why relying on free markets *up to* the point where people are not getting the healthcare they need *and then* dishing out subsidies is such a bad idea ..unless you believe markets don’t deliver optimal efficiency and single-payer would be more efficient (?!?)

Posted by: neil | Aug 27, 2007 2:53:08 PM

Ezra, you're on dangerous ground here because mcmegan's arguments are vile. Saying anything less than that only serves to justify her megaphone which, frankly, I don't she deserves for a large number of reasons.

To your arguments:

The government can't do it. It'll be like the DMV. It's "socialized medicine." Do you love waiting times? etc.
Yeah sure. Funny thing about that goverment, social security seems to work. Medicare seems to work. The entire bloated and mostly out of control defense establishment stills seems capable of blowing shit up.
So my rejoinder to the argument that the word "government" poisons it is, no, government removes the profit motive and insures everyone which is the way insurance is supposed to work.

It'll be too expensive.
Those of us who have health care already pay some of the highest rates on the planet. If we can get the administrative duplication and waste out of the system, it's possible we can improve it.

Incrementalism-as-obstruction. i.e, "We should have a more "American" system based on tax credits and deductions!" These proposals don't have the downsides of real reform, but they don't fix anything, either. However, they do make it seem like the politician "has a plan." See Giuliani, Rudy.
Tax deductions don't mean much if you aren't making anything. They're great to the folks who itemize and make decent or better money but if you think the magic republican phrase of "tax deductions" means anything to the folks for whom taking costs of pocket just isn't possible, you need to get out more.

National reform will fail, as it always has, and the cause will be dealt an enormous blow, just like in 1994. Better to be incremental and just cover kids or something.
Sorry, you lost me on this one. "an enormous blow"?

It'll reduce pharmaceutical innovation.
Pharma innovations is already stagnating. That is, unless it's an erection drug. Come on. Pharma will create things that people will buy. Does anyone really think that if all Americans could afford perscription drugs they'll buy less of them? What big pharma wants is what they have right now. Like the record labels, they're willing to fight their own customers to preserve a business model that is comfortable, not moral or efficient.

Oh, and once again, commenters like Soullite and Christmas are right on about mcmegan. Stop it Ezra. You're better than this. At least I hope you are. She's vile and that she gets a national voice is a symptom of the problems in our media.

Posted by: ice weasel | Aug 27, 2007 2:53:52 PM

McMegan isn't interesting, she's a bad person.

Soullite, do you ever go out into the light? You just make up half the things you say.

The reason I, at least, tend to harp on your linking/promotion of McArdle is that it's fairly different in character from the way you link to, say, Jonah Goldberg.

Thank God for small favors.

The extent to which people rail against McArdle is generally inversely proportional to the extent to which they've bothered to read carefully what they're railing about. She's fairly good at making her arguments.

Posted by: Sanpete | Aug 27, 2007 2:58:33 PM

Just like this article we're discussing, right Sanpete?

/plonk

Posted by: verplanck colvin | Aug 27, 2007 3:03:37 PM

Why are complicated arguments needed?

Last week was the right thought they had done a 'gotcha' momeent when some rube asked John Edwards at his bus window if he liked the movie SiCKO, and if so don't that mean that he thinks we ort to have a guvmit run system like they got thar in Cuba?!

Posted by: El Cid | Aug 27, 2007 3:03:49 PM

DAS: I can vouch for the greatness of the "new" NJ DMV (actually called the MVS). I was in fact writing a post about this until I saw yours. Anyway, it changed because McGreevey made it a point to change it. He hired better people to run it and streamlined it. Maybe the better people made it a point to train the employees better, I don't know.

Look at this passport mess we have. Is it any surprise an Administration which loathes governance and bureaucracy would allow this mess to happen? Then they go ahead and blame "bureaucracy" for it, forgetting about the fact THEY ARE IN CHARGE OF THE BUREAUCRACY! Forgetting the fact that we are supposed to have the "CEO President" in charge!

If the DMV is shit its because the people running it are incompetent or careless. Not because it's a government agency running it.

Posted by: Joshua | Aug 27, 2007 3:20:34 PM

I'll say what's left unsaid.

For a lot of us, denying health care is a form of murder.

Posted by: Karmakin | Aug 27, 2007 3:27:05 PM

"She's fairly good at making her arguments."

Yes and no. She's an ex-English major, so she's a good *writer*, but that isn't anywhere in the same zip code as being a good *analyst*.

Firstly, she's really, really fecking lazy with data. Really. Argue with her, and pretty soon she'll be Appealing To Experts She's Talked To.

Secondly, she's a Chicago GSB grad. That's OK, I know really sharp people from CGSB, but it leans her towards a crude application of cruder econ 101 models. There's been a wealth of research in the past thirty years on market failure and imperfect markets, and if you're gonna present yourself as an econ blogger, it'd help to be familiar with them.

Thirdly, she was burned on the whole left by being involved with Nader's PIRG when she was a young 'un. So she thinks most of the left is as exploitative, dishonest and wrongheaded as PIRG.

Posted by: Sock Puppet of the Great Satan | Aug 27, 2007 3:37:42 PM

"The extent to which people rail against McArdle is generally inversely proportional to the extent to which they've bothered to read carefully what they're railing about. She's fairly good at making her arguments."

The above is a factually false statement. She is horrible at making her arguments. She usually relies on the strawman for attacking liberals, but also has healthy doses of "facts" that end up being anectodal evidence. Additionally, she is afraid of making the final steps into libertarianism because it is so soulless that it horrifies even her, but then derides anyone just inches to the left of her. And finally, she doesn't know how to make her arguments short - they all seem to take several thousand words to make banal points.

Posted by: mickslam | Aug 27, 2007 3:56:40 PM

The DMV argument is a microcosm of a key part of the argument against national health care: simple refusal to acknowledge changed facts, gussied up in a variety of rhetorical tricks. A lot of DMVs did used to be bad...and they've improved. The Veterans Administration was once a disgrace...and the Clinton administration oversaw its impovement, and did so good a job that it took the Bush/Cheney administration years of serious effort to wreck it again. All the European national health care systems have been in place for decades and so their adoption struggle doesn't bear directly on the problems we'd fix...but Taiwan adopted national health care in the 1990s, with excellent results that do bear on ours. A lot of the statistics thrown around in arguments against national health care turn out to be obsolete as well as incomplete and massaged.

Posted by: Bruce Baugh | Aug 27, 2007 4:06:06 PM

Eric, lay off Megan. She's just a lovesick seventh grader with a crush on you. Or maybe that was a metaphor. You'll have to ask Dan Drezner.

Posted by: santamonicamr | Aug 27, 2007 4:15:54 PM

Am I the only one who's in and out of the DMV in less than 20 minutes every time I go? Maybe New York just got a lot more efficient than most states, but personally I think the "do you want something to become as slow and badly managed as the DMV" argument to be at least a decade past its prime.

Recently, it took me over 90 minutes for a change of address at the DMV in Chicago. I consider that pretty bad. It used to be better, they'd have dedicated lines for minor issues that used to go pretty fast. But now they've implemented this new computerized system that seems to bin people in such a way as to maximize wait times for everybody.

That said, wait times are considerably longer at nearby ERs. And at my old HMO a non-emergency appointment with my primary care physician was often scheduled as much as sixth months away.

Health care ain't Starbucks. You can drink all the free market happy juice you want, but none of that changes the fact that our patchwork health care reality is a nightmarish labyrinth where you won't have a hypothetical entrepreneur opening up Crazy Ed's House of Health, where you get treated in 30 minutes or your MRI is free.

Posted by: Royko | Aug 27, 2007 4:20:24 PM

IIRC, one of the most effective arguments in shooting down the 1994 health care plan was "You don't get to choose your own doctor" (Harry and Louise really hit on this). Might not be quite so effective nowadays, what with people herded into HMOs and PPOs with their in/out of system enrollments.

Also, sometimes they say "Post Office" instead of "DMV".

Posted by: FMguru | Aug 27, 2007 4:22:04 PM

"Folks konw I think McMegan is an interesting writer. Some of you even hold it against me."

Of course she's an interesting writer. She (Damn that Woman!) writes both you and I (and many others) off the page.

That I agree often with her ideas (as most around here do not) is not I think the important point.

She has got that manipulating the words thing, and yes I'm jealous.

No, she's never made me cookies.

Posted by: Tim Worstall | Aug 27, 2007 4:23:16 PM

And we should also stop caring for the sick, because that colon cancer is your own damn fault Mr. I-Don't-Eat-My-Fiber.
This made me laugh out loud.

Posted by: IIsabel | Aug 27, 2007 4:28:26 PM

Just like this article we're discussing, right Sanpete?

It's obviously a general claim, verplonken, like most of the others about her in this thread. The article here is complicated enough to make it less than an ideal case to judge by. I expect she wouldn't accept some of the interpretations the criticisms rely on, and would be able to explain others.

For a lot of us, denying health care is a form of murder.

Megan isn't for denying health care to those who need it.

Posted by: Sanpete | Aug 27, 2007 4:37:27 PM

Arguments dangerous to UHC? The innovation one doesn't strike me as an argument potent with the general public. The mechanism behind the idea seems like it requires some thinking; people hate that stuff.

Posted by: TJ | Aug 27, 2007 4:44:04 PM

'I've been trying to think more systematically about which health care arguments are dangerous to reform'

Since wisewon hasn't responded... how about the "cost growth" argument. I started out caring about other, typical arguments against UHC; but in reality, this is the only one that really resonates for me. I’ve get to see this properly addressed by UHC advocates, but am interested to see how a proposed UHC plan is going to manage this.

Posted by: DM | Aug 27, 2007 5:16:14 PM

Soullite is right, she's a horrible writer and thinker. If her writing and thinking reflects who she actually is, in some sense, she must be a horrible person.

Something that keeps getting left out of the health care "debate" although it figures largely in the education debate, is the comprehensive and coherent health care for all--especially for children--is an integral part of a healthy society for all. Without comprehensive and affordable or free health care there can be no serious response to any bio-terrorism threat. Anthrax? Small pox? TB? plague? the flu? Most americans simply won't be able to see a doctor in time to get any pandemic level illness diagnosed and isolated. The treatment facilities and beds aren't there. And the right to sick days or family medical leave that would enable doctors to quarantine sick people at home simply don't exist.

Since the first epidemiological insights grew out of the study of cholera and dirty water in cities we've known that individual health *is* public health in a lot of ways. And public health is, well, public and requires working collectively for a collective goal--good health for all or at least for most.

The entire thrust of the idiot McCardle's point is that good health is individual. Its not. Good health for society, and of a society, is collective. That's not a dirty word. Its just a fact.

aimai

Posted by: aimai | Aug 27, 2007 5:57:37 PM

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