Archives: June, 2009

Cato Experts Live-Blog ABC News Health Care Special

Cato health care experts Michael D. Tanner and Michael F. Cannon provided live commentary Wednesday night for ABC’s “Prescription for America,” a special program from within the White House on Obama’s health care reform proposal.

You can watch the program, and follow along below.

For more, visit Healthcare.Cato.org.

How Many Uninsured? It Does Not Matter

As my colleague Michael Cannon discusses below, in today’s WSJ Online, Carl Bialik examines the data on how many Americans do not have health insurance. Discussions like this one will be rehashed repeatedly during the coming health care debate, but they miss the crucial point: the U.S. should not expand government subsidy for health insurance whether the number of insured is 46 million or just 46.

The economics argument for subsidizing health insurance rests on the claim that private insurance markets do not provide fairly priced insurance. This is allegedly because insurers cannot distinguish the good health risks from the bad health risks and thus price insurance at a level only the bad risks are willing to pay.

This claim of “asymmetric information” is incredibly unpersuasive: absent regulation to the contrary, an insurance company can require any medical tests it wants and learn an insurance applicant’s health at least as well as the applicant. It can also condition coverage on relevant behavior, such as not smoking or maintaining a reasonable weight.

The problem is thus that insurance companies can determine all too well who is a good health risk and who is not, so they will price insurance accordingly if the law permits. This strikes many people as unfair, so they want to subsidize insurance for those born with unhealthy genes.

If insurance subsidies had few unintended consequences, this might be a reasonable form of social insurance. The problem is that subsidizing insurance exacerbates moral hazard, the tendency of people with insurance to consume too much health care. This is a crucial reason for rapidly increasing health expenditures.

Policy must therefore accept a trade-off: subsidizing health insurance will increase some people’s perceptions of fairness, but it will make the health care market less efficient.

A reasonable balancing of these two concerns suggests subsidizing insurance for the truly poor, but no more. In fact, the U.S. already does that via Medicaid. The uninsured are mainly people with too much income to qualify for Medicaid, or people eligible but fail to apply. Thus expansion of subsidized insurance to the currently uninsured, whatever their number, is likely to generate substantial inefficiency relative to any increase in “fairness” it creates.

Ron Paul at Cato: ‘Audit the Fed’

When Texas Congressman and former Republican presidential candidate Ron Paul speaks about transparency in the Federal Reserve, he sums up his argument with one simple question. Why not?

“Why in the world should this much power be given to a Federal Reserve that has the authority to create $1 trillion secretly?” Ron Paul asked a standing room-only crowd today at the Cato Institute.

Paul was on a panel of speakers, including Gilbert Schwartz, former associate general counsel to the Federal Reserve, to discuss a new bill that will audit the Fed for the first time in its history. This comes at a time when the Fed’s balance sheet has almost tripled, from just over $800 billion before the financial crisis to almost $2.3 trillion now.

“We will only win when the people wake up and realize that transparency is what we need,” said Paul. “When we know exactly what’s happening, there will be monetary reform.”

Watch the rest of Paul’s comments below:

F-22 and the Big Picture

f22_inflightTravis Sharp of the Center for Arms Control and Non-Proliferation has a good update on the Nukes of Hazard blog about the current congressional politics of the F-22, the Air Force’s favorite air-to-air fighter.

Secretary Gates and the Obama administration, you’ll recall, want to stop buying F-22s. Soon we’ll have bought 187 at $350 million a pop, depending on how you count. With few air forces out there that can rival ours, DoD, sensibly, would rather spend its billions elsewhere.

Congress isn’t so sure. The House Armed Services Committee narrowly voted to include $369 million in the FY 2010 defense authorization bill to keep the F-22 production line open. An amendment to strip that money from the bill didn’t make it out of the Rules Committee.  The Senate probably won’t include the funding in their version. The appropriators haven’t acted yet, but are generally pro-F-22 in both houses. So this will remain a live issue for a while, with resolution probably coming in conference. Meanwhile,  the White House just threatened to veto the defense bill if F-22 money is in it.

The fighter mafia that dominates (dominated?) the Air Force wants more F-22s but has been silenced by Gates, who stuck a non-fighter on the top of the service to tow the company line. Fighter generals on the way to retirement, however, can speak their mind and show Congress where the Air Force’s heart is.

The logic behind keeping the line open is simple. Politically, defense production lines are hungry mouths to feed, a concentrated set of interests that compel their representatives to favor continued procurement or export licenses. Advocates of defense programs understand that political demand will dissipate when the line closes. So when their program is in political trouble, they punt, and ask for just enough money to keep it open, trying to live to play another day.

We should stop buying the F-22. But I worry that doves consume their political energy arguing about the merits of particular defense programs, while mostly ignoring the bloated defense budget and the excessive commitments it underwrites. The F-22 is just a symptom of the larger malady. With all sorts of new spending commitments and a recession, this is a relatively good time to make the case against our hegemonic military posture and its extraordinary cost, fiscal and otherwise. That’s a way to kill the F-22, and more.

Washington Metro’s Problem: Too Much Money

The terrible Washington Metrorail crash that killed nine people has led to calls for more money for transit. Yet the real problem with Washington Metro, as with almost every other transit agency in this country, is that it has too much money – it just spends the money in the wrong places.

“More money” seems to be the solution to every transit issue. Is ridership down? Then transit agencies need more money to attract more riders. Is ridership up? Then agencies need more money because fares only cover a quarter of the costs.

Yet the truth is that urban transit is the most expensive form of transportation in the United States. Where the average auto user spends about 24 cents per passenger mile, transit costs more than 80 cents per passenger mile, three-fourths of which is subsidized by general taxpayers. Subsidies to auto driving average less than a penny per passenger mile. Where autos carry 85 percent of American passenger travel, transit carries about 1 percent.

When Congress began diverting highway user fees to transit in 1982, it gave transit agencies incentives to invest in high-cost transportation systems such as subways and light rail when lower-cost systems such as buses would often work just as well. Once they build the high-cost systems, the transit agencies never plan for the costs of reconstructing them, which is needed about every 30 years. The Washington Metro system, which was built as a “demonstration project” in the 1970s, is just a little ahead of the curve.

Now over 30 years old, Washington’s subways are beginning to break down. Before the recent accident, some of the symptoms were broken rails, smoke in the tunnels, and elevator and escalator outages.

Now we learn that the National Transportation Safety Board told Metro in 2006 to replace the cars that crashed on Monday because they were in danger of “telescoping,” which is what killed so many people in Monday’s accident. Also, the brakes were overdue for maintenance. Metro responded that it planned to eventually replace the obsolete cars, but didn’t have the money for it.

But it does have money to build an expensive new rail line to Tysons Corner and, eventually, Dulles Airport. Planners had originally recommended running bus-rapid transit along this route, but that wasn’t expensive enough so Metro decided to go with rails instead – at ten times the cost of the bus line.

The simple problem is that we have forgotten about the need to weigh revenues and costs. Instead, transit has become a favorite form of pork barrel and, for the slightly more idealistic, a method of social engineering, meaning a part of the Obama administration’s campaign to “coerce people out of their cars.”

That’s one more government program we can do without.

Cato Health Care Experts Live-Blogging Tonight’s ABC News White House Special

Tonight at 10:00 PM EST, ABC News will broadcast a “special report from the White House” on President Obama’s plan to revamp the nation’s health care system. Cato scholars Michael D. Tanner and Michael F. Cannon will offer live commentary and analysis when the program begins.

Don’t miss this opportunity to hear another voice in the health care debate.

Sign up below:

 

For more on Cato’s research on health care, visit Healthcare.Cato.org

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How Many Uninsured Are There?

The Wall Street Journal’s Numbers Guy tackles the question:

The Census Bureau estimates that the number of uninsured amounts to 45.7 million people. But the agency might be over-counting by millions due to faulty assumptions…

Even though legislation won’t cover many of them, illegal immigrants are especially difficult to enumerate: Few raise their hands to be counted. Prof. [Jonathan] Gruber estimates they make up about 13% of the uninsured today, or nearly six million people of that 45 million number…

Of the rest, some people are eligible for health insurance but don’t know it and many can afford it but don’t want it. About 43% of uninsured nonelderly adults have incomes greater than 2.5 times the poverty level, according to a report released Tuesday by the business-backed Employment Policies Institute.

He left out a few things, though.

The estimate of 46 million uninsured, which comes from a less-than-ideal government survey, has been the occasion of a fraud on the public.  For 20 years, the Church of Universal Coverage told us that 40-some million Americans are uninsured for the entire year.  Then, experts including the non-partisan Congressional Budget Office said that no, 40-some million is the number who are uninsured on any given day, and a lot of those people quickly regain coverage.  The number of Americans who are uninsured for the entire year is actually 20-30 million.  Yet the Church of Universal Coverage kept using that 40-some million estimate as if nothing had happened – even though the meaning of that estimate had completely changed.

The Congressional Budget Office also reports that as many as 15 percent of those 20-30 million chronically “uninsured” are eligible for government programs, so they’re effectively insured.

According to economists Mark Pauly of the University of Pennsylvania and Kate Bundorf of Stanford, as many as three-quarters of the uninsured could afford coverage but choose not to purchase it.  Again, according to the Congressional Budget Office, 60 percent of the uninsured are under age 35, and 86 percent are in good-to-excellent health.

Government intervention has made health insurance unnecessarily expensive for them, so these folks quite sensibly don’t want to be ripped off.  Mandating that they buy coverage is really about hunting them down and taxing them.