Reid and the Left Wing

I don't know squat about Harry Reid, but this article from CBS News about how the left is after him and threatening to boot him out of office if he doesn't pass a public option reminds me of the radical rightening (like that word?) that has occurred over the past decade in the Republican party. In that case, the religious right eventually figured out that they had the electoral clout in the Republican party and demanded that some bills start getting paid by the candidates that they got elected. Next thing you know, gay marriage amendments are being debated in Congress and the bulk of America is rolling their eyes. Republican candidates begin to seem petty and outside the mainstream, so they lose office. Yes, Bush helped, but then he's exactly the kind of idiot that the far right loved as a born again. When McCain kowtowed and took Palin as a running mate, the country threw up their hands.

So anyway, now the far left blogosphere is reaching the same conclusions and here we go. I wonder what Public Choice Economics (note I capitalize here but not on religious right) has to say about the scenario for the rise of a viable third party under these sorts of circumstances given the general apathy to most issues of the so-called swing voters.

Left vs. Right

I like this graphic.

Religious vs. Secular Oppression

It seems that the Taliban are really very much like the Khmer Rouge. Both want to achieve a simpler society and restore old norms and are willing to use violent oppression to achieve their aims. I wonder if it matters that the Khmer Rouge were motivated by secular Chinese Marxism and the Taliban are motivated by religion. Do you have to fight them differently?

The last post is fixed.

Fixed the link in the last post. Gap Minder seems to have changed the layout of their data. Either that, or I just gooned it up.

Health Care Reform: A Little Cost Data

Check out this GapMinder chart. When I just look at this as a cold body, it says to me that there's just more demand for health care as income rises.

In particular, Canada and the UK, which both have significantly more government involvement seem to be spending about the same amount on health care as the US for a given GDP/capita (i.e., when our per capita income was as small as theirs, we spent about what they're spending).

Other countries with well respected systems like Switzerland, Germany and France are actually spending more for a given per capita income than the UK and Canada, and more than we did back then.

A look at Luxembourg and Norway shows them to be on more cost-effective tracks, though interestingly they have also have very steep rises in cost over the past 5-7 years. It's easy to dismiss this as a size effect, and maybe we should, but I'm still curious.

If this is a good picture of what's going on, then really, we're not arguing about cost containment since the cost growth comes primarily from the high marginal value of health care in wealthier countries. Instead, what we're talking about are the following:

1. An equity issue concerning poor people who don't have health insurance (i.e., whether transfer payments should be increased to help them get insurance). Forcing everyone to buy insurance falls into this discussion, as it is done to reduce costs by eliminating adverse selection.
2. The economic inefficiencies concerning employment related health insurance, in particular lack of mobility in the job market because of the "pre-existing condition," and inefficient demand for large amounts of health care as a result of the tax system.

A caveat here is that it's not 100% clear that the health care spending data on the abcissa are inflation adjusted. I looked at the original WHO data and found that they are given as a percentage of GDP. Assuming that the dollar figures used are calculated by applying that percentage to the inflation adjusted per capita GDP numbers, then they would be.

Health Care Reform

Here's a nice exchange between me and my representative, Gabrielle Giffords, on health care. First, to her I write:

I voted for you and I voted for Obama. I am disappointed in the handling of health care reform. As viewed by the public, the process lacks clarity and focus. In my opinion this process needs to be put back on the rails so that the public can understand what is going on.

First, the objective(s) needs to be communicated. Are we about insuring the uninsured or reducing costs, or both? Second, why is this the right objective? Third, how will the plan accomplish the objective? Fourth, the costs need to be clearly addressed. Specifically, if the plan costs money, how can it be afforded after the terrible deficits run under Bush and the Keynesian spending spree that started this administration? Alternatively, if it saves money, who is losing out (i.e., someone was wanting that money)? Finally, why is the public sector the right choice for accomplishing the objective?

I voted for you and the president because I believed that you stood for factual honesty and critical thinking, not distortion and dogma. Please don't disappoint me. Neither I nor the nation can take it after the past 8 years of W.

To which she replies:

Thank you for contacting me about health insurance reform. I very much appreciate hearing from you on this critical matter.

Our country faces many challenges, but few would disagree that our single most important domestic problem concerns America's health insurance system. We are paying too much and are often subject to unfair practices such as denying coverage based on pre-existing conditions or imposing life time limits on care.

Nationwide, insurance premiums have doubled in the last nine years, increasing three times faster than real wages. According to the Department of Health and Human Services, last year the U.S. spent approximately $2.2 trillion, or $7,421 per person, on health care. This equals 16.2 percent of our GDP, nearly twice the amount of the next most costly nation. It is estimated that by 2040, one in every three dollars will be spent on health care.

Arizona's Eight Congressional District is especially burdened by America's broken health insurance system with the average constituent bearing the weight of these costs. Medical expenses contribute to half of all personal bankruptcies. In our state, out of pocket expenses went up by 32 percent during 2001-2006, with rural residents receiving a disproportionate share of these expenses.

As your Representative, I am paying close attention to what Arizonans think about this issue, and I am fighting for solutions that will work for us. I recently hosted a Tele-Town Hall to make it easier for people to participate in the discussion, and in May, I held a Health Care Town Hall that was attended by over 1,000 people. I have met with numerous doctors, patient groups, providers, hospital administrators, researchers and leading policy experts in Arizona and around the country. I am committed to working towards insurance reform where every man, woman, and child has access to affordable, quality health care and no one is unfairly denied coverage based on pre-existing conditions.

I have attached a statement on insurance reform that I recently wrote for the Arizona Daily Star. I hope you will take a minute to read it.

Changing our current system will be complicated, and I think that it is important to work in a bipartisan effort. I am also of the belief that we should not take a vote on this legislation until every member has had a chance to thoroughly read the bill and be able to explain it to his or her constituents.

As this debate continues in Washington, please know that I am listening to you and will continue to monitor this issue as the details of insurance reform develop. Don't hesitate to call or email me with your questions or concerns.

To receive regular e-mail updates on healthcare and my work as your U.S. Representative, visit www.giffords.house.gov to opt-in to my e-newsletter. It allows me to keep Southern Arizonans, like you, informed about the most recent activities in the House of Representatives and upcoming public forums I am sponsoring in the district.

What with it being my blog and all, I get the final word:

Thank you for your form-letter response to my concerns over healthcare, including a nice copy of your previously released prepared remarks. I appreciate the effort that you put into rousing emotional rhetoric concerning this issue as it is certainly important to rally the faithful when the opposition is so dead set on organizing to stop your efforts.

It happens though, that I neither support nor oppose what you are trying to do. I simply don't understand what it is. The paucity of facts in this discussion is underwhelming. For example:

1. You indicate that health insurance premiums have risen significantly, but there is no indication of the cause. Obvious possible causes for increased premiums include an aging and therefore more medically expensive population, increased willingness to pay for better treatments, epidemics of inactivity and obesity, or some sort of rent-seeking behavior by insurance companies or health-care providers. Is there any indication as to what the cause might be, because the appropriate solution is radically different for different causes?

2. Isn't there a one-step solution the problem of coverage denial based on pre-existing conditions: simply make it illegal?

3. Won't increasing the span of coverage to include those who presently cannot affort insurance necessarily increase the overall cost of health-care for those who already have it? I recognize that by requiring everyone to have coverage, the adverse selection problem can be reduced, potentially reducing insurance costs for the currently insured, but isn't that a smaller effect? Is there evidence that the reduced cost of emergency room care for the uninsured will offset this increase?

These are the sort of simple factual points that no one seems to be discussing, least of our nation's elected leaders. Again, I entreat you to set the standard for clear fact-based debate regarding this important issue so that those of us who lost faith in government under W. can hold our heads high in regarding our decision to vote Democratic in the past election.

I hate it when I agree with Pelosi

In my memory, the shrillness on the right about health-care is unheralded, and I agree with Nancy that the efforts to shout people down in town-hall forums is un-American. I think I need to go read some history, because I sincerely hope that this sort of thing has happened before and it's somehow normal--not a sign of the apocalypse.

While my libertarian leanings have always made me quite annoyed at the "government-can-solve-your-problems" attitude of the main-stream left, I now think that the bigger problem is probably the increasingly vocal and ideologically driven elements of the right who genuinely seem to believe that your either "for us or against us." Though they're a clear minority, minorities can come to power and do great harm.

The worst part is that I think their world view is made out of stupid.