Why Americans Pay Too Much for Health Care

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This book is published by Cato, and written by two lawprofs: David Hyman (from Georgetown) and Charles Silver (University of Texas). The Kindle version is a mere $1.99 at Amazon. Incredible deal. Downside: it's very, very long: print version is 592 pages. Although the last 20% or so of the book is devoted to footnotes.

My immediate take: It's a good remedy for people who are advocating "Medicare for All". After reading this, you'll be saying (if you weren't already): Are those people out of their freaking minds? Because Medicare is seriously broken, rife with waste, fraud, and abuse. Maybe we should fix it first, before extending its breakage to the entire populace?

Yes, Medicare is "popular". Which is why Democrats find "Medicare for All" to be a winning slogan. But the authors show why it's popular: it doesn't ask too many inconvenient questions before shelling out huge sums of cash. Its income is silently deducted away in people's paystubs. And politicians love it because they get to run it and take credit for keeping the goodies flowing. Of course, as New Hampshire's own Drew Cline points out: it's due to run out of money in a few years, and politicians are diligently ignoring that problem. (One guy who wasn't: Paul Ryan. For his troubles, now an ex-Congressman.)

But it's not just Medicare, pretty much the entire market for health care is dysfunctional. The authors recite one horror story after another, showing how terrible things are. Most of the problem is due to the nature of third-party payments, where consumers are insulated from normal market price signals. The system can corrupt even honest people, who can hardly be blamed for responding to the incentives it presents. (People do so with varying degrees of eagerness, of course.)

The authors also have a bone to pick with "Big Pharma", which uses all the tricks in the patent book to protect its fat profits. The stories here might have you nodding in agreement with Bernie Sanders. The authors have some ideas about reforming the patent system for life-saving drugs, which may work. (Unfortunately, a lot of pols seem to be in Big Pharma's pocket, and those that aren't seem to be more interested in using the industry as a whipping boy for their own political gain, not

The authors are (surprisingly) optimistic about the future; they have visions that an increasingly expensive and inefficient market will give rise to more and more "retail" medicine, more medical tourism, and cheap insurance against "catastrophic" medical costs.

That would be nice, but I'm less optimistic when nearly all the politicians and all the mainstream media have bought into the narrative that's brought us to the current dreadfulness.

Anyway: an interesting (albeit anger-provoking) read, and (as said) a very good deal via Kindle.

Last Modified 2024-01-24 6:53 AM EDT

URLs du Jour


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  • The College Fix reports that (in collaboration with the CongressCritter from that stupid state across the river, Chellie Pingree) Ocasio-Cortez tries to deplatform libertarian students by shaming their funders.

    The Bronx Democrat turned her wrath on big tech companies last week, but not for spying on Americans, promoting internal groupthink or censoring information at the government’s request.

    AOC, as she’s popularly known, is mad that they sponsored a libertarian student conference.

    She responded to a report by the progressive magazine Mother Jones that Google donated $25,000, and Facebook and Microsoft $10,000 each, to sponsor Students for Liberty’s LibertyCon.

    Irritating, but unsurprising, that Pingree and Ocasio-Cortez are trying to throw their political weight around in order to shut down pro-liberty gatherings.

  • At the Federalist, David Harsanyi notes another liberty-hostile candidate: Kamala Harris Sure Sounds A Lot Like An Authoritarian.

    Listen, it wouldn’t be fair to accuse presidential hopeful Kamala Harris of supporting state control over the means of all production. To this point she’s only focused on the energy, health care, auto-manufacturing and education sectors. Good candidates prioritize.

    In this age of hyperbole, I sometimes worry about overusing words like “socialist” or “authoritarian.” Yet, if we accept that an “authoritarian” is a person “who favors or enforces strict obedience to authority, especially that of the government, at the expense of personal freedom,” I’m not sure how anyone watching Harris’ campaign kick-off (sponsored by CNN!) could argue that her policy positions do not fit that description.

    For starters, here are some of the things that Harris believes the state can ban at expense of your personal freedom: private health insurance, your car, affordable energy, political speech, your guns, for-profit colleges, and government office holding for practicing Catholics. Of course, the media, complicit in normalizing these hard-left positions over the past decade, treat her agenda as the centrist option for voters. Who knows? Maybe in the contemporary Democratic Party it is.

    Can't wait for President Kamala!

  • At National Review, Charles C.W. Cooke is pretty irked with the Bad, Press.

    Our national press is a national joke. Vain, languid, excitable, morbid, duplicitous, cheap, insular, mawkish, and possessed of a chronic self-obsession that would have made Dorian Gray blush, it rambles around the United States in neon pants, demanding congratulation for its travails. Not since Florence Foster Jenkins have Americans been treated to such an excruciating example of self-delusion. The most vocal among the press corps’ ranks cast themselves openly as “firefighters” when, at worst, they are pyromaniacs and, at best, they are obsequious asbestos salesmen. “You never get it right, do you?” Sybil Fawlty told Basil in Fawlty Towers. “You’re either crawling all over them licking their boots or spitting poison at them like some Benzedrine puff adder.” There is a great deal of space between apologist and bête noire. In the newsrooms of America, that space is empty.

    If you get into the habit of presuming any single news report reflecting poorly on the right is false, you'll save yourself a lot of backtracking.

  • At The Hill, Alan Viard makes a subtle point: A deeper look at new wealth tax proposal from Elizabeth Warren.

    To understand whether wealth tax rates are high or low, it is helpful to convert them into equivalent income tax rates, which are more familiar and easier to understand. Consider a taxpayer who holds a long term bond with a fixed interest rate of 3 percent each year. Because a 2 percent wealth tax captures 67 percent of the interest income of the bondholder makes each year, it is essentially identical to a 67 percent income tax. The proposed tax raises the same revenue and has the same economic effects, whether it is called a 2 percent wealth tax or a 67 percent income tax.

    A 67 percent income tax is clearly a high tax rate. The tax rate is no less high when it is relabeled as a 2 percent wealth tax each year. Changing labels does not change reality. The 3 percent wealth tax that Warren has proposed for billionaires is still higher, equivalent to a 100 percent income tax rate in this example. The total tax burden is even greater because the wealth tax would be imposed on top of the 37 percent income tax rate.

    Put that way, it doesn't make a lot of sense. Put any way, it doesn't make a lot of sense. It's not designed to make sense; it's designed to appeal to naked envy and resentment, of which Liz hopes there's enough in the electorate to put her into power.

  • Related, at Reason from Ira Stoll: Are Billionaires Immoral? Democrats Are Staking Out Aggressive Anti-Wealth Platforms Ahead of 2020. In response to an AOC interview in which she denied that it could be moral for billionaires even to exist:

    My own sense is that the best moral defense of billionaires requires putting the socialists on the defensive by answering the billionaire question with some other questions. Would it be moral for politicians in Washington to change the laws so that becoming a billionaire in America would be impossible, no matter how much value an entrepreneur creates for customers and shareholders and society as a result of the entrepreneur's hard work, genius, and risk-raking? What would that proposed alternative system do to the American dream and to its traditions of strong property rights? Why scapegoat and demonize a few billionaires for public health problems in Alabama that they have nothing to do with?

    Won't we be more likely to make progress against poverty and disease if we avoid divisively linking those problems to the existence of a few rich people who aren't actually at fault for them? Is it a "moral world" where politicians can motivate millions of voters to blame a country's problem on a handful of wealthy individuals, and to suggest, without evidence, that long-term and intractable problems can be quickly solved if only tax rates were dramatically increased? Is the Democratic fixation with the billionaires (problem) and taxes (solution) much different from the Trump fixation on immigrants and the border wall?

    Even some of the better educated of my lefty Facebook friends buy into the "poor people are poor because rich people are rich" meme. Sad!

  • Cato points to SpendingTracker.org, a site which "assigns each member of Congress a spending score by matching voting records to Congressional Budget Office (CBO) scores for every bill affecting spending since 2009."

    Very cool. But for New Hampshire folks, it's sad, because all current/recent members from NH have scores in the "high" ($19 trillion) range. And there are a lot of members, I think all Democrats, in that ballpark.

    Some highlights:

    The lowest-spending Representative in the 115th Congress (and over his lifetime) was Michigan’s Justin Amash, who voted to cut roughly $165 billion during the 115th Congress. Nearly tied with Amash was Kentucky’s Thomas Massie.

    Senators Rand Paul and Mike Lee each voted to cut over $150 billion during the 115th Congress, with Rand Paul as the lowest-spending Senator. Surprisingly, democratic socialist Bernie Sanders voted to increase spending by the fourth-lowest amount, roughly $140 billion. By comparison, Republican Senator Marco Rubio voted for a net spending increase of roughly $330 billion, more than twice as much as Sanders.

    Rubio a bigger spender than Sanders? Hm. (My guess: it's because Sanders votes against a lot of Defense appropriations.)

Last Modified 2024-01-24 6:53 AM EDT