Health Care

I went to an amazing policy breakfast the other day on health care. It was hosted by the Maxwell School and Public Agenda and featured Drew Altman. Because of the breakfast, I am now a huge fan of Public Agenda (a group I knew nothing of before this) and I expect I will be paying more attention to them in the future.

Basically, the breakfast did a great job of highlighting the real differences between McCain and Obama's health care philosophies (and by extension the difference between Republicans and Democrats) - which is different than talking about their plans. Neither are likely to have their actual plans passed, so understanding their philosophies is more important.

Before I get into that though, Drew Altman made three important points that I want to mention. First, he said surveys show that people are more concerned with making health care more affordable - with being able to pay their bills when they receive health coverage. Percent of people with health insurance isn't as big a concern (except how an inability to afford coverage would affect them).

Secondly, he said that what we have seen recently is that as costs are increasing, health plans are charging higher deductibles and providing skimpier coverage. This is likely to continue unless something major changes.

Finally, he talked about what he thought was mostly likely to happen. He thought it somewhat unlikely that there would be an immediate major shift in health care policy. Instead, he predicted small changes that would build on the Children's Health Insurance Program or maybe a bigger program that moved towards universal coverage but would be phased-in if the economy improved.

Now, the major differences between the parties on health care:

Republicans:
-Want to move away from the employer-based system
-Believe a market-based approach can make health care more affordable
-Want less regulation on coverage
-If people have control over their coverage and knowledge of the real costs of their care, they will make better decisions and waste less money (health savings accounts are a move in this direction)

Democrats:
-Want to build on the employer-based system
-Want to move towards universal coverage
-Believe we need to regulate levels of coverage
-Buying health care is extremely complicated and public cannot make decisions about coverage

After hearing this, I think I came down on the side of Democrats. First, I think health coverage is a right not a privilege. Also, while I think we definitely need to do what we can to make health care more affordable, I don't know that I trust the market for this - especially if there is less regulation. Choosing health care coverage is a really complicated decision that involves many factors, some of which the buyer doesn't even know to consider. People will have to make decisions about deductible amounts, choice of doctors, and detailed levels of coverage for treatments. It's not that I think the public is stupid, but that there is naturally information asymmetry that the insurance companies can and do exploit.

Here is where my mind splits though. Above I said I think we need to make health care more affordable. I don't really trust government to be able to do this. The problem is that markets are often more efficient (not always, but often) but definitely not fair. Since so much of health care is about fairness (ie ensuring everyone has adequate coverage), markets cannot be trusted. But without some market pressure, we won't be able to afford to provide coverage for everyone.

I obviously need to do some more thinking about this. I think there is a lot of bad information out there (one-sided pieces like Michael Moore's Sicko for example), and I have not found much good information aside from this breakfast panel. There are some serious questions out there that I haven't heard good answers to yet, like: What are the real strengths and weaknesses of some of Europe's single-payer universal coverage systems? How much do they cost? Why are there extreme variations in costs between states that don't match variations in outcomes?

This is going to be a huge issue no matter who is elected. Costs are rising rapidly and for such an advanced country we have too many people who lack coverage. I will definitely be coming back to this issue. (After all, I didn't even touch on the lack of access to preventative medicine for people without coverage or the overall health of our country.) This is all I've got for now though.

What You Need to Know About Oil

If you are curious about why oil prices have changed so much recently (or even if you think you know), read this article in the Times. If you don't have time, I have highlighted the main points below. If you don't even have time for that, then I would send you away with this main point: Current capacity for the production of oil is flattening while global demand is rapidly increasing. Because of oil futures speculators, prices will fluctuate, but in the long term, prices will rise. We need to decrease our consumption and find alternate sources of energy. The author believes (as does Thomas Friedman, and as do I) that we should create an artificial price floor (through taxes) to accomplish this because every time prices decrease, we forget and we stop conserving.

Those Damn Speculators

According to skeptics like George Soros and Michael Masters, a hedge-fund operator, the only thing wrong with the oil market is the market itself. Speculators, they say, drove the price away from its "fundamental" value; worse, a new breed of institutional investor has been buying oil futures, hoarding the supply.

On the other hand:

Of course, capitalism demands that people, or at least investors, make bets. That is how resources are allocated and money is invested where it is needed; high prices communicate scarcity. You could even say the oil market has performed a vital service to the country by telegraphing the need to conserve and to develop alternative supplies.

Recent History of Oil Prices:

The reason that the history of oil is basically one of attempted price fixing is that, as technology has improved, drilling costs have fallen, meaning that prices have been under near-continuous downward pressure. Like most commodities, oil should sell for whatever the cost of producing one additional unit is — in this case, one more barrel. Economists call this the "marginal" cost. If someone charges much more than that, a competitor can offer to sell it more cheaply.

It’s only when oil is scarce that things become interesting. If there isn’t enough to go around, then the marginal cost no longer matters because, at the margin, there is no more oil to produce. Under such conditions, oil will rise to the price at which people stop using it — either because they drive less or because they find another energy source. This is called the price of demand destruction. Think of that as the upper bound on the price. With the twin shocks of the ’70s — the Arab embargo and the Iranian revolution — oil did reach an upper bound, jumping tenfold to $40 a barrel in 1981. Demand quickly collapsed, and the price eventually sank all the way back to the marginal cost, $12.

Low prices were good news for consumers but a mixed blessing for society. Since it takes time for oil companies, as well as consumers, to react to price changes, markets tend to respond with a perilous lag. In the ’80s, oil companies were spending billions looking for oil, and Detroit was retooling its plants to make smaller cars, even as the price of oil was collapsing.

In the mid-1980s the oil industry suffered a terrible slump. Thousands of petroleum engineers were fired or left the business. Congress lost interest in energy conservation, and projects to develop shale oil and other alternatives were dropped. In Europe, high fuel taxes meant that people still had an incentive to conserve. In America, families became unwilling to ride in anything but trucks.

Even as oil prices rose in this decade, big oil companies — still responding to the price signal of an earlier period — plowed most of their cash flow into dividends and stock repurchases rather than risk it on exploration. State oil companies overseas, like Saudi Arabia’s, which control four-fifths of the world’s reserves, refused to make the investment to develop their fields to full potential for fear of flooding the market (another reaction to low prices). For similar reasons, there was a lull in building critically needed refineries.

By the time oil companies woke up to the consequences of low prices, it was in some sense too late. There was "a missing generation of engineers," according to Daniel Yergin, the chairman of Cambridge Energy Research Associates and the author of "The Prize," a history of the oil industry. There was also a lack of drilling rigs and men to work them. Drilling costs soared, and equipment was often unavailable. Also, countries where oil is abundant, like Russia and Venezuela, were increasingly chauvinistic and hostile to foreign operators. Civil unrest set back production in Nigeria.

By the middle of this decade, various big oil regions — Mexico, Nigeria, the North Sea, Colombia, Venezuela — were experiencing production declines.

The lesson here is that a high price of oil is the only thing that forces us to conserve and invest in alternate energy. Hence the need for an artificial price floor.

Also, if you think compressed natural gas (CNG) is the solution to our problems, read this article. Basically, if we really want to decrease our dependence on foreign oil and fight global warming, we need to decrease our consumption, not change the form of our consumption.