The John Stuart Mill approach to Health Care Reform

October 21, 2009

(Guest Post by Matthew Ladner)

JSM once noted that if government would simply require an education, that it might save itself the trouble of providing one. He could have added trying to provide one at enormous cost, but let’s not quibble over details.

This was the approach to the Romney reform in MA, but that reform ignores the fundamental problem with our system: third party payers create a powerful incentive to ignore costs. The Romney plan did not address this central problem.

If you don’t believe it, give me an unlimited line of credit with your money at a Vegas casino and watch me transform into a gambling fiend.

The New York Times published an important piece suggesting a brilliant compromise: the government should mandate insurance, but only catastrophic insurance.

This would introduce supply and demand back into most of the health care market, which is precisely what is needed in order to curtail costs and thus prevent the continuing loss of coverage (which is a symptom, not the disease).

Government policy (both in the tax code and from Medicare and Medicaid) is directly responsible for the out of control costs we have experienced. Having quasi-socialized the health care system but without gaining monopoly power to dictate terms to health professionals, politicians have created a culture of “anything goes” in health care.

Paul Tsongas said it best “America is the only country that pretends that death is optional.”

The government, in essence, has created a health care culture which rejects the very essence of a government run plan, which is bureaucratically rationed care. Notice the scrambling to pretend that there are “no death panels” in the plan kicking around Congress. This is of course meaningless, as if there are no death panels there soon will be under a new name: Eurocare is all about having bureaucrats make cost/benefit decisions about health care. They withold treatment to 78 year old men with prostrate cancer so they can spend their limited resources on prenatal care.

Forget about arguing the ethics of Canadacare: after decades of anything goes Americans won’t go for it. If the Democrats pass it anyway, they are likely to rue the day. Put in death panels = driving off a cliff. Expanding coverage without rationing and death panels = faster fiscal suicide.

We’re caught in a trap…can’t walk out!

It seems to me then that some sort of catastrophic mandate/increased out of pocket expenses/health savings account approach outlined in the Times article far more profoundly sensible than the fiscal/political suicide pact currently under discussion.

Munchausen by proxy syndrome in health care might have been great fun for the politicians while it lasted, but with a $1.4 trillion dollar deficit this year, we can no longer afford it.


The Unions Have Lost Nick Kristoff

October 15, 2009

(Guest Post by Matthew Ladner)

Read it and weep K-12 reactionaries.

P.S.

Somewhere, John Rawls is smiling.


Over There (But Not Over Here)

September 21, 2009

Several years ago I was part of a delegation sent by the U.S. Department of Education to a conference in China on private education.  The U.S. Dept of Ed believed that encouraging the expansion of private education in China would help promote democracy.  Apparently, they thought private schools were good for democratic values over there, but not over here. 

I was reminded of that experience while reading a recent New York Times article about severe problems with education in South Africa.  The piece states:

Despite sharp increases in education spending since apartheid ended, South African children consistently score at or near rock bottom on international achievement tests, even measured against far poorer African countries. This bodes ill for South Africa’s ability to compete in a globalized economy, or to fill its yawning demand for skilled workers. And the wrenching achievement gap between black and white students persists.

Sound familiar?

And what does the NYT tell us is a central part of the problem:

The teachers’ union too often protected its members at the expense of pupils, critics say. “We have the highest level of teacher unionization in the world, but their focus is on rights, not responsibilities,” Mamphela Ramphele, former vice chancellor of the University of Cape Town, said in a recent speech.

I see.  Teacher unions over there = bad, while over here = good.  Sometimes you have to get people outside of their vested set of domestic interests to see how they really think the world works.


Union Busting — Good for the NYT, Bad for Everyone Else

May 4, 2009

The NYT has threatened to shutter its Boston Globe subsidiary in 60 days if its unions don’t agree to various cuts.  According to the Times’ own coverage:

“The company has said since early April that unless the unions make wide-ranging concessions, it will close The Globe…”

Hmmm….  What would the New York Times say if someone else, like let’s say Walmart, threatened to close down its units because unions would drive costs too high.  Oh, wait, they did write an editorial about that on August 16, 2008.  It begins:

“It is hardly news that Wal-Mart will do whatever it takes to keep unions out of its stores, from closing down a unionized outlet to firing pro-union workers.”

I guess it is hardly news that the New York Times would engage in the same practices that they find deplorable if allegedly done by others.

And who could forget this gem of an editorial by the Times on December 28, 2008?  Just a few months ago the Times seemed to think that expanding union power was great because it would raise wages, which was necessary for economic recovery:

“Even modest increases in the share of the unionized labor force push wages upward, because nonunion workplaces must keep up with unionized ones that collectively bargain for increases. By giving employees a bigger say in compensation issues, unions also help to establish corporate norms, the absence of which has contributed to unjustifiable disparities between executive pay and rank-and-file pay.

The argument against unions — that they unduly burden employers with unreasonable demands — is one that corporate America makes in good times and bad, so the recession by itself is not an excuse to avoid pushing the bill next year. The real issue is whether enhanced unionizing would worsen the recession, and there is no evidence that it would.

There is a strong argument that the slack labor market of a recession actually makes unions all the more important. Without a united front, workers will have even less bargaining power in the recession than they had during the growth years of this decade, when they largely failed to get raises even as productivity and profits soared. If pay continues to lag, it will only prolong the downturn by inhibiting spending.”

  Come on NYT!  Can’t you follow your own advice?  Do your part for the economy and raise those Boston Globe wages higher rather than slashing them.

(edited for typos)


Please Ignore the Huge Pile of Payola Behind the Curtain

March 18, 2009

(Guest Post by Matthew Ladner)

The New York Times turned in a must read article on Arizona State University President Michael Crow:

He quickly made a name for himself, increasing enrollment by nearly a third to 67,000 students, luring big-name professors and starting interdisciplinary schools in areas like sustainability, projects with partners like the Mayo Clinic and Sichuan University in China, and dozens of new degree programs

But this year, Mr. Crow’s plans have crashed into new budget realities, raising questions about how many public research universities the nation needs and whether universities like Arizona State, in their drive to become prominent research institutions, have lost focus on their public mission to provide solid undergraduate education for state residents.

I love the way the term “quality” is used by Dr. Crow. Maybe it is just me, but it certainly appears to me that ASU has been seeking to create the appearance of quality more than the reality. As JPGB readers will recall, ASU’s four year graduation rate is 28%, lowest among the peer institutions as identified by the Education Trust.

Case in point, National Merit Scholars- ASU has a lot of them. But **ahem** there is a little problem identified by the New York Times:

Arizona State University recruits National Merit Scholars nationwide with a four-year $90,000 scholarship, a package so generous that Arizona State enrolls 600 National Merit Scholars, more than Yale or Stanford. Through the cuts, Mr. Crow has kept that program, even while proposing to cut a scholarship for Arizona residents with high scores on state tests, a proposal the state regents turned down.

In their promotional materials, ASU boasts of the number of National Merit Scholars they enroll, but doesn’t bother to mention the obscenely large bribe offered in order to get those National Merit Scholars. If I wanted to be cruel, I’d compare this package to another university and…

Okay, so I’m cruel: the Education Trust identified the University of Indiana Bloomington as the highest performing peer institution for Arizona State based on 4 year graduation rates (over 50% for IU). Last year, their National Merit Scholars had an average package worth $13,609 each.

For some reason, ASU feels compelled to offer almost seven times as much as IU. Maybe the weather is just better in Indiana. Oh wait, you don’t have to hang around at ASU in the summer, so it can’t be the weather.

Well, um, some people don’t like palm trees…


Izumi’s Video Op-Ed in the New York Times: Vouchers in Sweden

March 16, 2009

Good stuff-Check it out.