Columnist.
The idea that John F. Kennedy was really a conservative, rather than the liberal icon he is so often depicted as, is the thesis of a new book by Ira Stoll. The idea is seconded by George Will in a column in The Washington Post. Are they correct? Before examining the case, let me make an important distinction. I seem to be one of the few writers who sees conservatism and liberalism as sociologies, not ideologies.
Here is something that is odd. For the past six years President Obama and the Democrats in Congress have waged a relentless attack on the health insurance industry. In the most recent iteration, the president assures us he is not responsible for the wave of health insurance policy cancellations. The insurance companies are. Okay, so where is the other side?
If you are inclined to believe Barack Obama's claim that people losing their insurance are giving up skimpy coverage for much better benefits, read the editorial in Monday's Wall Street Journal. Then read it again, and again, and again. Edie Sunby has a rare form of cancer that is almost always fatal. Yet she is alive, thanks to the efforts of doctors in San Diego, at Stanford University and in Texas. Over the past year, UnitedHealthcare has spent $1.2 million on her medical expenses. But she has just been informed that her insurance is being cancelled.
It's as though two completely separate conversations have been going on. From day one, the health policy community has correctly seen the Affordable Care Act as an attempt to completely change the health care system. This isn't even controversial. It's accepted by all as an undisputed fact.
Until recently the taxi cab business in virtually every city in the country functioned like a medieval guild. And as Adam Smith might have predicted, we consumers are worse off for it. But for me at least, things have changed. Say I need a ride to the airport. I can tap an icon on my cellphone and a car will arrive, usually within five minutes. I normally take whatever vehicle is available; and that's most likely a black town car. But if I have several passengers with me and we have a lot of luggage, I can order a van. A map appears on my cellphone and I can actually see the car's avatar as it wends its way in my direction. I'm continuously updated on the expected time of arrival.
The liberal view of health care is easy to describe: health care is too complex and complicated for individuals to make good choices on their own. Therefore they need bureaucracies -- employers, insurance companies or government -- to make decisions for them. (See, for example, [Austin Frakt](http://theincidentaleconomist.com/wordpress/chart-of-the-day-complexity-and-health-care/).) What this view overlooks is that the primary reason why the system is complex is because the bureaucracies are meddling with it in the first place.
Now that the problems with implementing ObamaCare are becoming increasingly apparent, Progressives are touting "single payer" health insurance as a replacement for ObamaCare. For those who haven't been following the debate for the past 50 years, "single payer" is what we used to call "national health insurance," and before that "socialized medicine," and before that "government-provided health care." Proponents often explain single payer to lay audiences simply as Medicare-for-All. By the way, advocates of single payer, who now call themselves "progressives," used to call themselves "liberals," and before that "socialists," all in the hope that continual relabeling will somehow make their ideas seem sensible.
"If you like your health insurance you can keep it," Barack Obama promised the voters on many occasions. About 20,000 part-time employees of Home Depot recently found out how false that promise is. The company announced that it is ending its health insurance coverage for its employees and sending them to the new health insurance exchanges. They will be joined by employees of McDonald's, Disney, CVS Caremark, Staples, Blockbuster, and many others.
Have you ever noticed how often cities where there are very few Republicans elect Republican mayors anyway? Or if they don't elect a Republican, they elect a Democrat who acts like a Republican. New York City is known for being a bastion of liberalism. But the city hasn't had a real liberal mayor for almost 40 years. When Jersey City, New Jersey, elected Republican Bret Schundler as mayor, there probably weren't more than five Republicans living in the whole city. Democrats have outnumbered Republicans in Dallas County, where I live, for quite some time. Yet Dallas has never really had a liberal mayor.
The ObamaCare health insurance exchanges are supposed to open for business next Tuesday. Despite huge subsidies and despite daily publicity, these exchanges are expected to enroll only 11 million of 48 million uninsured Americans over the next year. Those who do enroll may not be happy with their experience. We now know quite a lot about how these exchanges are going to function and the picture doesn't look good.
In 1984, Singapore instituted a revolutionary idea: a system of compulsory saving for medical expenses. That was the same year my colleagues and I at the National Center for Policy Analysis introduced the idea of Health Savings Accounts in this country. After almost three decades, Singapore has now come to the attention of a lot others, including a book by Brookings, and a whole slew of posts by bloggers. At the risk of disappointing you, Singapore does not have a free market for health care. What it does have is an alternative to the European/American welfare state, in which private saving and private insurance do what employers and governments do in other countries.
Do you know of any place you can go to find a rational, well-thought out economic argument for liberalism? I can't.
We spend about twice as much as other developed countries as a fraction of national output. Yet our results are mediocre. Public and private spending is growing much faster than our income -- putting us on a course that is clearly unsustainable. It appears we are buying quantity instead of value. Outcomes vary wildly from state to state. And programs that target the poor seem to be backfiring instead.
One of the strange things about the market for health insurance is that almost none of us ever sees a real price. More than 90 percent of people with private coverage get it through an employer. Employers, on the average, pay about three-fourths of the cost and the remaining share tends to be the same for every employee -- irrespective of expected health care costs. In most states, the only people who face real premiums are in the "individual market," where individuals and families pay for insurance out of their own pockets. Yet the Affordable Care Act (ObamaCare) will outlaw the pricing of individual risk (medical underwriting) by year's end. Health insurance, therefore, is very different from just about every other form of insurance.
The decline of racial barriers in the job market and throughout the economic system -- at least outside the south -- had very little to do with liberal legislation. But the lack of economic progress by the black community as a whole is in many ways the result of the liberal approach to politics. On balance, liberalism has been an obstacle to black progress, not a help.
The Affordable Care Act will have a profound influence on how doctors practice medicine; and the way hospitals care for patients. The clearest explanation of the Obama administration's vision for health care reform comes from Harvard Medical School Professor Atul Gawande, who says medicine should be more like engineering, with all doctors following the same script rather than exercising their individual judgments.
Consider that ObamaCare aims to insure an additional 27 million people. If economic studies are correct, once they are insured these people will try to double their consumption of health care. On top of that, millions of employees and their employers will be forced to upgrade their health insurance -- making it more generous (and more expensive) than it currently is. ... Then there is a lengthy list of preventive services everyone is supposed to insure for, with no copayment or deductible. ... What we are describing is a huge increase in the demand for care. But the Affordable Care Act does nothing to increase supply. This is virtually guaranteed to put upward pressure on prices. To the extent that prices are prevented from rising, it will create enhanced rationing by waiting. And almost anything patients and doctors do to circumvent the cost of waiting will also add to the money cost of care.
Republicans are virtually unanimous about one thing: They want to repeal and replace the Affordable Care Act (ObamaCare). But what would they replace it with? Actually, there is a serious GOP proposal. It's called the Patients' Choice Act, sponsored by Sen. Tom Coburn (R-Okla.) and Rep. Paul Ryan (R-Wisc.). ... The GOP proposal is actually more "progressive" than ObamaCare. And, unlike the Democratic approach, it solves problems rather than creating new ones. Yet Republican politicians almost never mention it.
What's the most important lesson to take away from the bankruptcy of Detroit? It's that when governments promise benefits they are unwilling to pay for, the system can very quickly come to resemble something designed by Bernie Madoff. ... Now here is something interesting -- did you know that it is illegal under federal law for a private corporation to do what Detroit did? ... So here is the obvious public policy question: why do we let cities and towns all across America do what is illegal for private companies to do?
