Scientific American on Health Care

I love Scientific American for two reasons. One, it is amazing to see new advances - or theories - in science as they are unfolding. Two, in appropriate situations, they weigh in on policy and politics. When they do, I trust them because, more than anyone else, I feel they are free from ideology and base recommendations on science and data.

In this month's issue, they write about health care and what needs to be done to control costs. Here is what they say about Obamacare and Paul Ryan's plan:

Politicians have acknowledged the crippling cost of medicine, yet their proposals do little to fix these basic flaws. For instance, replacing Medicare benefits with vouchers that individuals can use to buy their own health insurance, as was recently proposed by House Committee on the Budget Chair Paul Ryan, merely shifts more of the financial burden to private citizens. And most of the cost-saving initiatives found in the Affordable Care Act are demonstration projects—not large-scale reforms. The factors that inflate health costs must be addressed widely and directly. Fortunately, promising solutions are beginning to emerge:

What they recommend is not particularly new, but they give these proposals more credibility: reduce fragmentation, phase out fee-for-service, and compare effectiveness of procedures.

Now, if we are really going to compare Obama v. Ryan, we would acknowledge that Obamacare does this stuff, albeit slowly, and Ryan's doesn't at all. But it is good to see the scientific community weighing in. And it is good to see that they support Democratic plans - although they clearly think they need to be more ambitious.

Ryan on Healthcare

Paul Ryan is getting a lot of attention for his budget plan, including his plan for medicare. I think what he is saying needs to be analyzed and responded to. So here is a good quote from WashtingtonStakeout (hat tip Paul Krugman - I didn't actually know this website).

There are three facts about medicare that you simply can’t dispute: 10,000 seniors are retiring everyday with fewer workers going into the workforce to pay for them; healthcare costs are skyrocketing at about four times the rate of inflation, which threatens medicare’s ability to give affordable care; and number three, the non-partisan experts agree that Medicare is going bankrupt. So Medicare’s status quo is bankruptcy and that threatens healthcare not only for current seniors but obviously for future seniors, so I believe a patient-centered healthcare system — reforms that put the patient at the center of the healthcare system, not the government — are the best for people who need healthcare and they’re best for the economy, and they’re the best way to avert a debt crisis.

To start, let's assume that his three facts are true; I don't see anything I disagree with. But even if all the things he says are true, his solution isn't the only option based on those facts.

If Medicare is going bankrupt, then we have a few options. One is to increase funding. Another is to decrease services - either by cutting spending on the government side, or, as Ryan proposes, by making it a voucher program and underfunding it. My main problem with Ryan's plan is how he describes it; he tries to say that by using vouchers, he won't be underfunding services and that markets will magically bring down prices so that services won't be cut. This is stupid. He is cutting costs by cutting services - plain and simple.

A fourth option would be to keep it government-funded but to change incentives and structures to bring down costs. What is driving increased medical costs is in part an aging population and in part unnecessary services driven by our for-profit, fee-for-service system. Obama's health care plan plays with fixes, but only does so as pilots - afraid to change too much too soon. It is a prudent approach, but it means health care costs won't change very soon - instead all we can expect is that it might bend the curve so that future costs are less than we are projecting.

In retrospect, I think maybe he shouldn't have been so prudent. By taking on health care and only expanding coverage and doing modest pilots on cost-control, he left the door open for conservatives like Ryan to talk about cost control and to propose terrible schemes like consumer choice.

Either way though, the point is that Ryan may be right that Medicare is not on solid footing, but his plan is the least fair, least effective and therefore least desirable option out there.

Post Tries to be Reasonable About Gay Marriage

I do find it interesting that even conservative papers like the Post are trying to make anti-same sex marriage arguments sound reasonable. They even acknowledge “the frustration of gay couples who insist that they be treated the same as everyone else.” Unfortunately, that’s not enough to convince them to allow it.

Of course, the editorial falls on two familiar but illogical arguments. First, they try to say that marriage as an institution promotes procreation and gay marriage will undermine procreation. The problem is that society - and government - is perfectly willing to accept heterosexual couples that are obviously marrying for love and have no plans to have children. If we were honest about wanting marriage to be only about children, there would be a question for couples seeking a license asking if they can and intend to have children. But there isn't because heterosexual love is okay, homosexual love isn't - but reasonable people don't want to say it that way.

Second, they argue that allowing marriage would prevent religious freedom. We do not condone racism, even if it is part of someone’s religion. Religious freedom is not unlimited. We should never condone bigotry, even if someone is hiding behind their religion. Unfortunately, it takes time to recognize bigotry.

Now, I am willing to accept exemptions for religions for now as a first step to get more people used to the idea. And after society gets used to idea, we might finally see opposition as illogical and only explainable as bigotry. And at that point, we won't need a religious exemption. And we'll be happy to promote marriage for love, whether it be heterosexual or homosexual.

On Growth

Dear Conservative,

I find Republican plans to grow the economy so frustrating. They are a one-trick pony with little understanding of what makes capitalism function.

Their one trick is of course tax cuts. In their mind, all capitalist systems need is less taxes and a government always gets out of the way. Granted, I think this is mostly an attempt at pandering to a base that is rabidly anti-government, but I am disappointed at how they either pander against their better judgment or don't have the judgment enough to know that government serves an important function.

The truth is that our capitalist system has been as successful as it has been because of certain government investments. Over the long-term, our government has invested in research, infrastructure, including roads, power, railroad, ports, as well as significant investment in education and the creation of a legal system and security that is necessary to protect confidence in a capitalist system.

As we are mired in a major recession, it is enraging that Republicans are in a race to the bottom as each trots out programs that will cut the most taxes and therefore have to gut government spending and program. They claim they are proposing pro-growth policies, but if they actually understood capitalism, they would favor the right kind of government spending to promote growth, instead of pretending that all government spending, excluding the military, is bad spending.

A real pro-growth policy would increase spending on these items: education, infrastructure and research - and maintain spending on our legal system. By investing in education, we'd further improve the quality of our workforce and make it more likely that new inventions and innovations start here. And big gains could be made in inner cities were education outcomes are so poor.

By investing in infrastructure - whether it is a smart grid or otherwise improved electricity transportation or rail, roads and ports - we'll be allowing our businesses to be more productive than they otherwise would be. We can set the groundwork for more cost-effective power distribution and usage and decrease costs for businesses. And whether it is high-speed rail or other forward-thinking and smart transportation items, we can similarly make our businesses more productive. And research can help our firms develop new technologies and medicines that will change the world - and bring profits to domestic firms.

All of these things should be considered public goods - things that otherwise would be under-produced in our capitalist system. And one of government's best roles is in providing public goods. Unfortunately, the Republican party is too ideological to see any role for government, which means the miss opportunities for actual pro-growth policies and actually helping our economy for the future.