Archives: 09/2013

A Democrat Reexamines His Party’s Position on Health Care

An excerpt from David Goldhill’s new book, Catastrophic Care: How American Health Care Killed My Father – And How We can Fix It

I’m a Democrat and once held views about health care common in my party. But the more I’ve looked at our system, the more I’ve come to believe that the obsessions of our political debate – universal access, health insurance regulation, cost control – are irrelevant to the real problems that have created our mess…

[T]he frustrating reality is that despite more than sixty years of government efforts – representing the work of both political parties – we are moving further and further away from what we want. Prices are higher, more people are excluded from needed care, more excess treatments are performed, and more people die from preventable errors. Why?

Goldhill explains why at a book forum on Catastrophic Care this coming Wednesday, September 18, from 12-1:30pm at the Cato Institute. Click here to register.

There is a Great Deal of Ruin in a State

Much of the current debate about the aftermath of the Arab Spring, and frustrations with Iraq, Afghanistan, and now in Syria, implicitly or explicitly concerns the type of states that might emerge (Democracies? Dictatorships? Friends? Foes? Stable regimes of any stripe?). Beyond these basic uncertainties, there is a general frustration with the tragedy of persistent conflict, corruption, and poor governance in many of these areas.

Alas. Building a state, building any form of political order, is hard. Rarely does it emerge without a struggle. It’s tempting to think either that democracy is the optimal form of government, or that ANY form of government is preferable to an ongoing mess. Both may be correct. But, a move towards one political order necessarily entails a move away from another. And, crucially, the interests of the current political order will be threatened by this change from the status quo. And those who stand to lose will fight to avoid that loss.

This is part of what makes statebuilding so hard for outsiders. Foreign involvement can and does shape both conflict and statebuilding. But this influence is mediated by domestic actors who have their own interests, and for whom such alliances are often strategic means to (quite rationally) pursue their own goals. Failures to understand who stands to lose or gain from which outcomes and options magnify the risk of outcomes interveners don’t like.

In part because of this dynamic, outside assistance is not necessarily a shortcut to the mess of statebuilding. There will be winners and losers. And many will try to shore up their wins by taking what they can when they can get it. And by getting rid of their enemies—in ways we find repulsive.

Statebuilding is hard. Implicit or explicit proposals to pursue it are often accused of forgetting recent lessons on these difficulties. But we forget our own history, too. America itself experienced multiple flashes of unrest before the Revolution. The United States went through two constitutions in less than a decade, experienced multiple rebellions, fiscal and monetary crises, riots by unpaid soldiers and farmers facing foreclosure, and decades of severe and persistent corruption. Unresolved international issues led to the War of 1812. Unresolved domestic issues produced a bloody civil war in the 1860s, and unrest a century later in the 1960s.

Why do we expect others to emerge more seamlessly and with such immediacy? It would be marvelous. But it seems unlikely.

Missouri Lawmakers Override Veto to Enact Good Samaritan Law

In January, Missouri legislators introduced the “Volunteer Health Services Act.” The bill expands health care access for low-income residents by eliminating the regulatory barriers Missouri previously imposed on out-of-state doctors and other clinicians who want to provide free charitable care to Missouri’s poor. Yes, every state government prevents some doctors from giving away free medical care to the poor. As I wrote in “50 Vetoes:” 

Volunteer groups like Remote Area Medical engage doctors and other clinicians from around the country to treat indigent patients in rural and inner-city areas. States often prevent these clinicians from providing free medical care to the poor because, while they are licensed to practice medicine in their own states, they are not licensed to practice medicine where Remote Area Medical is holding its clinics.

Remote Area Medical has had to turn away patients or scrap clinics in California, Florida, and Georgia…After a tornado devastated Joplin, Missouri, Remote Area Medical arrived with a mobile eyeglass lab, yet state officials prohibited the visiting optometrists from giving away free glasses.

It appears that Missouri legislators, if not the governor, have learned their lesson. The legislature approved the Volunteer Health Services Act in May, and sent it to Gov. Jay Nixon (D), who vetoed it. But yesterday, both the Missouri House and Senate voted to override the governor’s vetoMissouri now joins states like Tennessee, Illinois, and Connecticut that have enacted similar Good Samaritan laws. 

The Missouri law also shields clinicians from liability for simple negligence in malpractice actions. I’m not a really a fan of letting legislatures shield doctors from liability for their own negligence. In my view, doctors and patients should choose and adopt their own med-mal rules via contract. But this part of the law may have little effect. Missouri’s Volunteer Health Services Act still leaves clinicians liable for injuries resulting from gross negligence, and judges and juries may weaken this shield by stretching the definition of “gross” negligence.  

Rather than enact massive and unaffordable new entitlement programs like ObamaCare’s Medicaid expansion, states should follow Missouri’s lead and eliminate this and other barriers that government puts in the way of getting health care to the poor.

(HT: Patrick Ishmael of the Show-Me Institute.)

Immigrants Didn’t Take Your Job – The Byron York Edition

Byron York’s anti-immigration reform piece relies on at least three weak intellectual crutches:

  1. York assumes that immigration reform will import millions of immigrant workers for jobs that do not exist. In reality, immigration reform would allow more immigrant workers to come in response to job opportunities. Throughout American history, immigrants come when there are jobs for them and stop coming when there aren’t. Unemployment rates, economic growth rates, and employment growth in industries where immigrants tend to work are great predictors of immigrant flow. In the aftermath of the housing construction collapse and Great Recession, the number of unauthorized immigrants dropped, and the cross-border flow shrank to a level not seen in 40 years.  Unauthorized immigrants don’t come when there aren’t jobs they can fill, and neither do legal workers. York doesn’t explain why that relationship would suddenly change.
  2. York ignores demand – the other half of the supply and demand model. Assuming that immigrants are just workers ignores their impacts on the demand side. When immigrants buy goods, services, rent or buy property, or start firms here, demand is stimulated. Immigrants, like the rest of us, are more than just workers in a labor market. We also consume what is produced by that market. Excluding the worker from the U.S. through immigration restrictions would also exclude the consumer. According to a University of Georgia study, Hispanic and Asian Americans have $1.9 trillion in annual purchasing power. Those groups of new Americans, mostly added in recent decades due to increases in immigrant and subsequent births, are more than just workers. Future immigrants will be more than just workers too.   
  3. York relies on the lump of labor fallacy, implying that more immigrant workers somehow decrease the quantity of jobs available to American workers. Besides immigrants mainly coming when employment is available, stimulating employment creation once here, and creating firms– there are not a fixed number of jobs in the American economy. If there were a fixed number of jobs, then the large scale movement of women into the post-World War II labor force would have resulted in mass male unemployment. The opposite occurred.

The rest of Mr. York’s piece relies on anecdotes from a biased sample that refuses to deal with the arguments and evidence that support immigration reform.    

Set Back 9-0 At High Court, SEC Turns To Congress

In February, in Gabelli v. SEC, a unanimous Supreme Court rejected the Securities and Exchange Commission’s argument that a statute of limitations deadline for its enforcement actions should not begin ticking until it gets around to discovering that securities laws have been violated. In so ruling, as Cato had urged in our amicus brief, the Court struck a blow for basic fairness as well as reasonable statutory interpretation: stale charges are the hardest to defend against, given that witnesses, memories, and documents have often scattered, and citizens deserve a right to get on with their lives rather than face battles over how to interpret financial transactions that took place many years in the past.

It’s hard to win really lasting victories against the continued advance of federal power, however, because agencies so often just come back for another round. Sure enough, the commission is now seeking to recapture much of the ground denied to it by the Court, and even some new ground. Here’s Mike Koehler’s analysis at FCPA Professor:

The SEC is now pushing Congress to double its existing five-year time limit (applicable to Foreign Corrupt Practices Act offenses and many others) to ten years.  Senator Jack Reed (D-RI), a high-ranking member of the Senate Banking Committee, reportedly intends to introduce legislation this fall.

But the SEC already has several arrows in its quiver, such as the discovery rule [which by statute applies to some claims not at issue in Gabelli] and the fraudulent concealment doctrine, to extend the five-year statute of limitations in many cases.  Moreover, a statute of limitations is largely [meaningless in practice] in most corporate SEC enforcement actions given that [pressures for] cooperation, and not necessarily the law and the facts, … motivate most corporations under SEC scrutiny to sign tolling agreements suspending the statute of limitations or to waive statute of limitations defenses altogether.

In short, the SEC faces few meaningful time constraints in bringing corporate enforcement actions.  For instance, the SEC’s most recent Foreign Corrupt Practices Act enforcement action – in May against the French oil giant Total S.A. – was based on conduct that allegedly occurred between 1995 and 1997 and which the SEC began investigating in 2003.

The gray cloud and uncertainty that SEC scrutiny represents hangs over companies and its shareholders for far too long and can have wide-ranging, negative business implications.  Justice is not promoted by extending this period of uncertainty by doubling the statute of limitations to ten years.

The SEC not surprisingly supports this proposal.  Simply put it would make the SEC’s job easier.  However, ease of enforcement has never been a proper consideration in a legal system based on due process and the rule of law…. 

Read the whole thing here.

When Does 5 Weeks of Training Beat 4 Years of Higher Ed?

…when the training is doled out by Teach for America and the higher ed. is a traditional teachers’ college. That’s the conclusion of a new study by Mathematica Policy Research, a respected purveyor of quantitative social science research. The salient details are summarized by Politico:

the researchers found statistically significant gains, which they calculated as the equivalent of about two and a half extra months of learning for students of TFA recruits…. The TFA teachers got better scores from their kids than a comparison group of teachers who went through traditional university training programs.

It kind of makes you wonder, what are they teaching in those four years of university instruction? I haven’t seen a comprehensive recent rundown of the subject, but back in the 1990s a top-flight journalist, Rita Kramer, spent a year visiting teachers’ colleges all over the country. What did she find? Well, she called her book Ed School Follies: The Miseducation of America’s Teachers.

I talked a little more about the TFA study with Bob Bowdon at ChoiceMediaTV.

Obsession with Syria Obscures Other Middle East Problems and Pertinent Lessons

The Obama administration and most of the U.S. foreign policy community have become so obsessed with Syria that other important developments around the world are receiving inadequate attention. In a piece over at the National Interest Online, I describe some of the key trends in South Asia and East Asia, two regions that are more important than the Middle East to long-term U.S. security and economic interests.

Crucial events include India’s growing financial woes, the simmering tensions between China and its neighbors over territorial disputes in the South China and East China Seas, and Japan’s increased willingness (in large part because of its problems with China) to boost its military spending and adopt a more confrontational stance toward Beijing. 

I also note that Syria is hardly the only source of worry in the Middle East itself. The renewed sectarian violence next door in Iraq is escalating at a frightening pace, Sunni-Shiite tensions in Bahrain are moving from a simmer to a boil, Libya is imploding, and Egypt is perched on the brink of civil war. The problems in Iraq and Libya hold pertinent lessons for those Americans who are eager to embark on a war against Syria. After all, those were Washington’s last two military crusades to oust odious dictators. And to be blunt, they have not turned out well.

Since the early spring, the level of bloodshed in Iraq has reached alarming proportions. And much of the violence reflects bitter sectarian divisions similar to those that make Syria such a fragile political entity. Iraq after the United States overthrew Saddam Hussein has not turned out to be the peaceful, democratic, multi-religious society that George W. Bush’s administration touted as the goal of U.S. policy. 

The situation in Libya is even worse. Overthrowing Muammar Qaddafi has led to an awful aftermath. The horrifying September 11, 2012 attack on the U.S. consulate in Benghazi that killed Ambassador Christopher Stevens and three other Americans was an early symptom of the chaos that has made Libya a thoroughly dysfunctional country. Today, a growing number of militias (many of which have rabidly Islamist orientations) have established small fiefdoms throughout the country, and the national government in Tripoli becomes increasingly impotent. Libya’s oil production has plunged, and with it the government’s principal source of revenue. 

Given the dismal outcomes of Washington’s last two military ventures in the Middle East and North Africa, one would think that proponents of a crusade in Syria would be sobered by the experience. But warhawks such as Senators John McCain and Lindsey Graham, Representative Peter King, and Weekly Standard editor William Kristol appear to have learned nothing from those debacles. More prudent figures in Congress and the broader foreign policy community need to overrule their wishes.