He is We?

Don,

Yet another example of the Anointed Ones knowing what is best for us and becoming frustrated when we disagree.

Terry

>Even Adam Smith, the grandfather of supply-side economics

Dave,

Adam Smith was definitely not a supply-sider. If you are going to use labels, at least get them straight.

Brobdingnagian: Thank you. Have not heard that word in a few years....refreshing. Swift is giving you a HT.

This is a little bit weird, Don. Here, you claim that Scott Brown's victory in Massachusetts is proof that the most progressive state in the union doesn't want this national healthcare reform bill to pass. Then, in your next post, you claim that politics has nothing to do with getting things done and everything to do with convincing your constituents that you should be re-elected.

So didn't Brown just hoodwink the people of Massachusetts into thinking he was better than his opponent. Perhaps the people just really didn't like her. Maybe she rubbed them the wrong way, and that's how the Dems lost the seat.

Which is it?

It was thought the public wanted a health care plan when Hillary hashed one out.

The the public began to learn of the contents.

What people want is to help others at little cost to themselves and to gain health care benefits, again at little cost to themselves.

The government cannot deliver this.

What the people want is imaginary and all politicians can deliver is a further debasement of reality.

The promises always sound, uh, promising, and people like that. When the details are revealed, the people learn what they don't want.

Krugman is following the general pattern of intellectuals by verbally transforming himself into "the nation" and speaking on behalf of what he thinks the people should have, and not what they really want. The arrogance of self-annointed, surrogate decision-makers knows no bounds.

As opposed to Mr. Boudreaux, who does the same thing, but with whom you happen to agree.

The door swings both ways.

Errr, no. Libertarians and our ilk (I love having an ilk -- everybody should have their own ilk) don't want to force anybody to do anything. We do, however, resist being forced ... when other people's choice of solution is to force everyone else to adopt their solution. So no, you are comparing apples and orangutans. Krugman would be happy to be dictator ... because he could FINALLY solve all those pesky coordination problems. Finally! Vote Krugman for dictator! He'll save the economy if we only give him enough money to stimulate it.

Except Dr. Boudreaux pointed out that polls (you know, numerical representations of what people are thinking in reality) support his claim. As well as an earthquake election on Tuesday. Or were you born on Wednesday or Thursday and missed that one?

Earthquake election?

Here's a quote from Scott Brown:

"I voted for health care here.... we're past campaign mode and I think it's important for everyone to get some form of health care. So to offer a basic plan for everyone I think is important... there are some very good things in the national health care plan that is being proposed"

Just two weeks ago, polling in MA showed "43 percent of Massachusetts voters support the Democratic national health care plan now making its way through Congress, versus 36 percent who oppose."

I can make polling say what I want, too.

The distinction between Don Boudreaux and Paul Krugman is simple but profound, and does not derive from polls.

Paul Krugman believes that he knows what's best, and that what he chooses is best for the people.

Don Boudreaux believes that he knows what's best, and that the people individually choose what is best for the people.

Both believe they know what's best, certainly. The difference is in the impact of each upon the freedom of choice of the individual. Don's claim to superiority in "knowing best" is not that he knows what's best for healthcare, but that he doesn't!

constrained (Boudreaux) versus unconstrained (Krugman) visions

Have any of you considered that the Senate bill is unpopular because many of the meaningful reforms were stripped? Polls showed the public supported health care reform until the political process turned it into a dog and pony show.

Krugman has stated, elsewhere, that he doesn't think the bill is perfect, but it's a start and better than nothing. Rather than taking his statement in isolation, I find it prudent to consider Krugman's statements on the whole when attempting to distill his intent.

Then again, whenever I see a Boudreaux letter to the New York Times in my RSS reader, my first thought is, what nitpick does he have with Krugman today?

The public supported health care reform when it was promised as a free lunch. Everyone likes a free lunch.

Public opinion really started to shift once the true costs became apparent and once the populace had a chance look in the legislative kitchen and see exactly how our congressional cooks are preparing the meal.

Of course, the lovely trick of the healthcare "reform" debate is that not everyone supports the same final form. Certainly, we all support "healthcare reform", vaguely phrased like so. Do we all of us support every reform that Congress is suggesting? Well, no. And as news of the contents of the various bills has leaked out, it has appropriately been met with mixed reactions.

As you are reading a blog whose readership trends strongly libertarian or conservative, our response to its contents is certainly not unexpected.

Krugman has shown himself to be an ignorant partisan hack so many times now that he doesn't deserve any further "consideration."

A bill which makes the entire health care system much worse than it is currently is not "better than nothing".

I don't find Don taking issue with Krugman's completely illogical ramblings "nitpicking".

Why would Krugman or you trust the same process that turned the original, well intentioned bill into a "dog and pony show" to fix this "less than perfect, but better than nothing bill"?

I don't expect them to fix it. I doubt Krugman does either. But, I do see a large portion of the population saying "No!" to everything without proposing alternatives. If Don doesn't like the current bill, why doesn't he make constructive suggestions instead of writing letters that smack of petulance?

The constructive suggestion is: STOP HAMPERING THE MARKET. Sheesh. Compare the market for food with the market for education. The first is mostly free and the second is mostly hampered. And what are the legislators always needing to do? School aid reform, or education reform, or Leave No Child Behind. Interfering with markets doesn't improve on them -- it just guarantees that you'll have to do it again. People are not chess pieces to be pushed around.

When all else fails, let's try freedom.

"I doubt Krugman does either. But, I do see a large portion of the population saying "No!" to everything without proposing alternatives."

Welcome to the restriction effectively imposed upon us voters. We typically have two choices when it comes to the booth: Democrat and Republican. The clarion call of each party has become, "We're not the other guys!" This simplifies our choices greatly. Democrats are currently largely supportive of the suggested healthcare reform, while Republicans are largely opposed.

Our choices are thus only "yes" and "no".

Polls are the same way.

"Do you support the proposed healthcare reform, yes or no?"

"Yes we can, but no we don't" tends to be the order of the day when all we have the real power to say is "yes" or "no". Don is, after all, a columnist and professor, not a White House correspondent or politician. Of course, were he either of the latter, I doubt any of us would be reading his blog.

"Constructive suggestions" have been made throughout this process (tort reform, removal of state line restrictions, etc). Since trial lawyers and insurance companies don't like such reforms (less $ for trial lawyers, more competition for insurance companies, respectively), the Dem's won't give them a chance in Congress.

Tort reform, according to the CBO, reduces costs by less than 2%. http://www.cbo.gov/doc.cfm?index=4968&type=0

The President has said he is "in favor of figuring out ways to lower malpractice insurance for doctors, because in some cases it's way too high, especially for OB/GYNs, neurologists." http://www.washingtonpost.com/wp-dyn/content/ar...

I don't see any reason to direct blame at a specific party. Especially one with an extraneous apostrophe.

While the CBO doesn't possess a crystal ball (i.e. it can be wrong), a 2% reduction is a reduction.

Also, there are other suggestions on the table. Personally, I'm on my second year of an HSA with catastrophic insurance and couldn't be happier. What would make me happier is if tax law didn't make it advantageous for employers to provide my health care and I would go out and buy it like I buy auto or home insurance.

Marcus,

I agree with you. But don't waste your time and energy to discuss healthcare on this blog. The equivalent would be to discuss the value of a free market economy with a die-hard Marxist.

You can point them to OECD data on healthcare showing how mediocre and expensive US healthcare compared to all other "socialist" OECD members is and they will first refute OECD findings or second come up with some cancer success story or third raise the issue of rationalizing and euthanasia. These people pervert Austrian economics and are mainly on an ideological crusade. There are much better blogs on Austrian economics from George Mason University, although starting with 2010 they don't want to be labeled Austrian any more. For the obvious reason.

Mister Boudreaux seems to spend most of his time scanning the US media for crime against the free market mantra. Then he lectures people and fires of a letter saying pretty much the same thing all the time: "Listen you progressive idiot. You're dead wrong. Only a truly free market is the solution to the problem. Actually with a truly free market we would have not a single problem left. Finally utopia."

Please reference this OECD data.

Seth

Why does the United States spend so much more on health than other countries? 09-Oct-2009

The United States spent 16% of its national income (GDP) on health in 2007, which is by far, the highest share in the OECD and more than seven percentage points higher than the average of 8.9% in OECD countries. This presentation was given by Mark Pearson, Head of OECD Health Division, to the U.S Senate Special Committee on Aging.
http://www.oecd.org/dataoecd/5/34/43800977.pdf

and

OECD Health Data 2009 – comparing health statistics across OECD countries 01-Jul-2009

The number of doctors per capita increased 2% per year on average across OECD countries between 1990 and 2007, but in some countries the trend is reversing. These are some of the findings from OECD Health Data 2009, the most comprehensive source of comparable statistics on health and health systems across the 30 OECD countries.
http://www.oecd.org/document/54/0,3343,en_2649_...

Actually the figures I posted once here were 2009. I must look them up again and post the relevant links. But I think these links should guide you in the direction. For more go to OECD site and search for healthcare. Plenty of stuff there.

Thanks for the links Stephan. Did you happen to read page 5 of the first report that you linked? Very interesting.

On that page is an admission that aggregate stats like life expectancy are not good measures of the effectiveness of health spending on outcomes. Then they show two stats, survival rates of breast and colorectal cancer. The U.S. ranks 1 and 2, respectively by fair margins. Ask those extra survivors if they think the extra spending in the US was worth it.

There's also an admission that the U.S. innovates and delivers new products to consumers faster than other nations. There's also a more choice and less, or no, rationing by waiting list.

The two charts on p. 5 that I am still chewing on are Charts 6 & 7, which show higher hospital admission rates per 100k for asthma and diabetes. US ranks high here. I'm not sure I'd agree with their conclusion on why. I think, perhaps, part of the explanation they gave already and resides in my previous paragraph.

I'm happy to see that the OECD is open to this line of thinking. Perhaps, if they use better, richer information on why we choose to spend more (though some of that extra spending is driven by needless government intervention), others will want some of that and we can save more lives.

Re: your second link, I'm not sure what that's telling me. Is that to refute the idea that socialized medicine chases docs away? If so, any reason you decided not to specify that more of the growth is coming from foreign-trained physicians?

Seth,

Actually the second link is about the overall data. I just realized it's behind the OECD paywall. Sorry. Due to job I've access. I will try to update you tomorrow on that. Then you can crunch more numbers. And YES these cancer findings are one of the rare things the US can boast about :) Cheers. Posted from Stephan's iPhone.

One thing? The non-existent waiting lines, innovations that make it to consumers quicker and more choice -all mentioned on the same page of the report - are three more things the US can claim. Now we're up to four, five if you count the two specific cancer results separately.

Stephan,

Why is spending more on health care automatically assumed to be bad?

We choose to spend more on a great many things.

Unlike European countries, we spend a lot more on elective procedures like infertility treatments and the premature births of multiple infants that result from them. We spend a lot more on dental care too and we have much prettier teeth to show for it. We spend because we can. Millions of people can afford to buy health insurance but choose not to buy it. Some of us don't because we can self-insure. Why should government dictate how much we spend and that those of us who don't want insurance must buy it?

The government has already screwed up health care in this country. We don't disagree that it's all messed up. We just don't trust government to fix it because government is the one that screwed it up in the first place.

With all due respect, the oddest thing about "free markets" is that they're free. You may believe that legislation is required to tame excesses, but please don't conflate such control with a free market.

You'll also find us to be realists. I'd wager that none of us here believe that free markets will result in a utopia, especially not Don. Why? Because this is imperfect humanity we're dealing with. The very word "utopia" is properly a mockery of the concept, meaning "no place". However, what we do seek is improvement, and what we do believe is that improvement is best sought after when each flawed individual makes their own choices than when 435+50+1 flawed individuals make it for all of us.

Also, you state that this blog perverts Austrian economics while giving no concrete examples. Sadly, I can give few examples of my own for its adherence, as I am poorly read on the topic. However, as it stands, your accusation of its deviance is as baseless as any claims I could make regarding its adherence.

Then why is congress not implementing a wildly successful plan from another country? Of course, one of the most successful plans is Singapore's. Their plan uses medical savings accounts, Singapore has life expectancies on par with OECD countries that have national plans, but spends far less on health care than all.

I bet you would dismiss the Singapore plan in a second becuase it has GASp savings acccounts.

People like you and Marcus are the ones who cannot have a reasonable discussion, and rant on about passing a TERRRRIBLE bill. I bet you would go nuts if I said we should invade Iraq, becuase while it is a terrible plan we should do something.

Hmmm ... you lost your bet. I'm one of this rare "socialist" Europeans who actually went along with GW to invade Iraq. I didn't buy his argument of WMD, but I think it's always a good idea to get rid of tyranny. Summary on Iraq: I was agreeing with the arguments brought forward in The Economist in favor of this war.

On healthcare I think the most suitable model for the US would be Switzerland. But Singapore is also OK. The main point about healthcare is, that the current system is a shame. That's it.

Most here would agree the current system has problems, but will differ on the solutions. Most here would never settle for a bad solution, one that may make the current system worse and not better. I am also confident most here would design a way better system than Krugman or Congress.

I'm pretty confident that Krugman would settle on a model like universal basic healthcare and who is wise enough to upgrade must pay for it. Let's face it: that is also the road we're going down in Europe. The promise to have universal healthcare with all whistles and bells attached without paying for the bells is unsustainable.

I don't disagree with you, Stephan. However, the legislation proposed is worse than any system in any European country.

In countries where socialized medicine has not provided for the population adequately, private insurance and private practice has filled the gap. The legislation proposed in America prohibits insurance companies from offering insurance people want (the government dictates what is and isn't acceptable). Doctors who accept Medicare and Medicaid patients cannot take cash from those same patients for things medicare and medicaid does not cover. I don't see how creating a worse system than we have now is better than doing nothing.

I agree. BUT what actually is happening is that instead of coming up with alternatives there's just praise of the status quo? That's a little bit wired or? Take the public option. I mean as far as I understand it's an option. And option does not mean government dictate. You can opt out and go along with private insurance if you wish so. So?

And what about best practise? All EU systems have their very own shortcomings. But the US is in the excellent position to evaluate and choose. But here we've a cultural blockade. Because the average citizen thinks the average EU citizen is on the verge of being Marxist any rational evaluation is from the beginning ruled out.

Finally the broken US system of government. This whole thing with super-majorities for each and every issue. Your founding fathers would rotate in the grave, if they would know about this filibuster bullshit. Personally I would suggest before tackling healthcare the US citizens restore government procedures to clarify who is in charge.

Stephan, both my husband and I are immigrants to America. I lived in parts of Western Europe before coming here, so I'm pretty aware of the cultural differences. It's a long discussion, but Americans are generally less collectivist. IMO, that has a lot to do with the fact that Americans tend to be culturally different from each other. European countries are relatively small with relatively more homogeneous populations. Thus, "one size fits all" collectivist plans are naturally less accepted here. Not to mention, we have the constitution which limits government. I'm oversimplifying, of course, but you can't ignore these things when comparing.

The public option would not be an "option". Instead of reinventing the wheel, I'll just provide links to what has been previously written. The big point is that it will usurp the private sector because it will not have to compete on a level playing field. This makes the public option significantly worse than the systems you are familiar with in Europe.

http://www.cato-at-liberty.org/2009/10/30/putti...

Yes. It's complicated. And there are for sure arguments pro and contra. But sorry ... a CATO link isn't something which adds a cent. They are notorious for biased assessments. I don't bother you with reports from center for american progress either, or? This is a little bit cheap. We should settle on things like OECD, IMF and alike. Anyhow we won't solve the problem today. Now it's up to congress.

You are free to reject Michal Tanner's argument. You're also free to post arguments from whatever organization you want. This has nothing to do with the organization that produces them and everything to do with the argument itself. Who presents the argument is irrelevant.

Incidentally, both the right and the left agree that the public "option" is not an option. It will absolutely kill private insurance in the United States. The only difference in their views is that the left thinks this is a good thing and the right thinks that's a bad thing.

I don't think Europeans would find it a good thing either. Ironic, really.

It's late. Here ;-) I'm about to destroy the statistical good health record of Austria by sipping a lot of Viennese wine. Unfortunately I'm literally Austrian. I think you're wrong. Anyhow have a nice day. Posted from Stephan's iPhone.

btw, I used live in Austria. Very pretty.

I lived and studied in the States. Cool place, great people otherwise I would give a damn about this debate :) At the end of the day it's not my healthvare theatre. Posted from Stephan's iPhone.

No, you're wrong! Alcohol is very good for the heart ;)

Great post.

Singapore's life expectancy is higher than OECD countries.

Singapore spends 4.5% or so of GDP on healthcare - much less than half the percentage spent by most OECD countries with socialized healthcare.

And, at least MSA's leave some free market aspect for all to enjoy. It is also a plan that truly would get bipartisan support. Knowing that a national plan will materialize, I prefer a national plan with MSA's, and a progressive high deductible catastrophic component.

I agree. It's the best alternative with a government component.

The equivalent here is HSA accounts. As I understand Singapore, basically what happens in is the government guarantees that at minimum level of care. If you have cancer, it will be tended to but the care will be basic. If you wish to have something more than basic care, then you have to pay out of your HSA account. Most people pay. Health care providers compete for those HSA dollars, which goes a long way to reducing costs.

I find that this type of place can be the best place to discuss topics like this because it helps to hone my thoughts on the subject in question.

That, and I enjoy being antagonistic.

"That, and I enjoy being antagonistic." Well, then you will have a lot of fun.

And you're right on "hone my thoughts on the subject". Cass Sunstein has an interesting theory on group polarization. Basically it says: "To become a radical, hang around with people you agree with." That is what exactly happens here.

well, if you want to hone anything, you're free to do it here.

If you ever try to offer an alternate opinion on DeLong's blog, it will be deleted. So, if Sunstein is correct, you guys should be extremely polarized by now.

<2% is still a reduction. Most of the provisions in the health care bill will raise costs and premiums (especially the coverage mandates).

"The President said..."

If he REALLY believes it, he'd ask for tort reform- modest reductions in premiums are better than rising ones. But Obama recieves tons of money from trial lawyers, so he doesn't want to ask for anything that will make their pockets lighter.

"I don't see any reason to direct blame at a specific party."

Republicans have proposed reofmrs such as those I have mentioned. Democrats won't let those proposals be deabted, much less voted upon. All Senators who voted for their version were Democrats (sans Lieberman, who was one), and the vast majority who voted for the House version were also (if not all of them). They control both houses and the White House and are the only ones wanting this to pass (not Republicans, and certainly not the general public). The reason they insist on doing it now, is because they have the best chance of getting away with it.

And the Democrats are the only ones receiving large campaign contributions from various influence peddlers?

The bill sucks. It sucks because the Dems are spineless and it sucks because the GOP is not constructively contributing. It sucks because congressmen on both sides of the aisle are more concerned with their next reelection campaign than they are with public welfare.

However, that doesn't mean the bill is devoid of useful clauses.

Unless your argument ends with Social Darwinism, I don't see how you can find tenability in leaving the health care industry as it is. Even Adam Smith, the grandfather of supply-side economics, believed the market needed an infusion of morality to function properly.

What's wrong with social darwinism? That is, why shouldn't society evolve as it naturally evolves? How is it better that society should submit to the will of a self designated elite?

Of course the Democrats aren't the only ones who receive money from special interests. I never said they were.

The GOP isn't being allowed to contribute- the bills proposed have been put together without Republican input.

The public welfare will not be helped by these bills. A few uninsured will gain insurance, sure. But or nation's responsiveness to emergency care, and cancer survival rates will be hurt tremendously (compare our numbers to the UK). Costs will not go down, but will rise, due to the moral hazard created by having the government pay for so much, while the individuals who benefit will pay so little (if anything).

"Unless your argument ends with Social Darwinism, I don't see how you can find tenability in leaving the health care industry as it is."

I don't think it should be left as-is, I've already mentioned two reform proposals. I do think "as-is" is better than either of the bills being proposed.

"Even Adam Smith, the grandfather of supply-side economics, believed the market needed an infusion of morality to function properly."

Where's the morality in forcing people to buy what they don't want. That "morality" of which you speak can be found in private charities, in the fact that ER's cannot deny coverage, and elsewhere. That may not satisfy your vision of what is moral, but who are you to say what Smith meant by "moral"?

The answer to your question is Jonathan Swift's adage: "You can't make a silk purse of a sow's ear."

The bill is a total POS.

It's funny how Lennon hated capitalism but couldn't figure out which one was the "evil capitalist." Still an amazing song, though.

Note to self...look for opportunities to use the word "Brobdingnagian" in casual conversation (but first figure out how to pronounce it.) I love it! :-)

The Dude: We dropped off the damn money...
The Big Lebowski: We?
The Dude: I! The Royal "we"! You know, the editorial...

"it is the one state that has the most simular plan in place. And the people STILL hate it."

Errr.... no. Mass. people would have elected someone who voted against the Romney plan in Mass. if they really hated it. Instead, they voted Scott Brown, someone who not only supported Romneycare, but voted in favor of it in the Mass. legislature. He ran on a platform against the Senate version, because it's not "fiscally responsible" and he was going to show Obama how "we" (ie. Mass.) did it (ie. Romneycare). Conservatives are delusional if they think the Mass election results was a vote against mandated/universal coverage. http://www.youtube.com/watch?v=Ygy0HbbKVM8

Not only is Massachusetts the most liberal of states, it is the one state that has the most simular plan in place. And the people STILL hate it.

Can we expect anything else from this useful idiot?

"reveals that Mr. Krugman’s arrogance has reached such Brobdingnagian proportions that he mistakes his own desires for those of the American public."

This is the unifying and universal fatal conceit of the useful idiots

Is it real? Or just a rhetorical device? Either way its bad. If its real, he's arrogant. And if its rhetoric, he's manipulative.