Tag: public choice

Holman Jenkins: ObamaCare Is Part of the Insanity, Not Its Cure

I’m a week late on this, but Holman Jenkins has an excellent discussion of why health care costs and pricing (not the same thing!) are insane, and why ObamaCare will only make it worse:

Duke University’s Clark Havighurst [wrote] a brilliant 2002 article that describes the regulatory, legal and tax subsidies that deprive consumers of both the incentive and opportunity to demand value from medical providers. Americans end up with a “Hobson’s choice: either coverage for ‘Cadillac’ care or no health coverage at all.”

“The market failure most responsible for economic inefficiency in the health-care sector is not consumers’ ignorance about the quality of care,” Mr. Havighurst writes, “but rather their ignorance of the cost of care, which ensures that neither the choices they make in the marketplace nor the opinions they express in the political process reveal their true preferences.”

You might turn next to an equally fabulous 2001 article by Berkeley economist James C. Robinson, who shows how the “pernicious” doctrine that health care is different—that consumers must shut up, do as they’re told and be prepared to write a blank check—is used to “justify every inefficiency, idiosyncrasy, and interest-serving institution in the health care industry.”

Hospitals, insurers and other institutions involved in health care may battle over available dollars, but they also share an interest in increasing the nation’s resources being diverted into health care—which is exactly what happens when costs are hidden from those who pay them.

Put aside whether President Obama could have pushed real reform if he wanted to. ObamaCare as it emerged from Congress fulfills the insight that any highly regulated system ends up benefiting those with influence, i.e., health-care providers and high-end customers, not those of modest means.

What are ObamaCare’s mandates on individuals and employers except an attempt to force back into the insurance market those who have been priced out by previous “reforms” so their money can be used to prop up a system of gold-plated coverage that mostly benefits those in the highest tax brackets? What are ObamaCare’s minimum coverage standards except a requirement that these customers buy more costly coverage than they would choose for themselves so their money can be used for somebody else?

I include a lengthy excerpt from Robinson’s excellent article in my chapter for the Encyclopedia of Libertarianism.

How Government Actually Works, Especially Unaccountable, Multi-Jurisdictional Government

In my book Libertarianism: A Primer, I have a chapter of pop public choice called “What Big Government Is All About.” The Metropolitan Washington Airports Authority isn’t really big government, just a local D.C.-Virginia-Maryland authority to run a couple of airports. But it demonstrates some of the problems you can expect from economic entities that don’t face a market test. Here’s how the Washington Post story today begins:

Meet the Kulle family: mom Helen, daughter Ann Kulle-Helms, son-in-law Douglas Helms, son Albert, daughter-in-law Michele Kulle and Michele’s brother, Jeffrey Thacker.

They all worked for the Metropolitan Washington Airports Authority. All at the same time.

And what about Dad, I wonder. No job for Dad?

Anyway, officers of the agency don’t seem perturbed by the story.

“There were no clear-cut guidelines,” said MWAA board member H.R. Crawford, who will leave the board next month when his term expires.

Crawford, who has had at least three relatives, including a daughter-in-law, work at the agency, said family members are employed frequently, particularly among board members.

“If you ask a third of those folks, their relatives work there,” he said. “I never thought that we were doing anything wrong.”…

“This is a government town and an agency town,” Crawford said. “If there’s a possibility that you can hire a relative . . . it was the norm.”…

“This is not a patronage mill,” said Davis, whose daughter worked in the fire department for two months in 2011. “Dozens of employees’ kids worked there.”

At this point the response of good-government liberals is always: Pass an ethics law. Yeah, that ought to work.

MWAA’s ethics code prohibits employees from hiring, supervising or working with relatives. They also cannot supervise family members — directly or indirectly — or “have influence over their work.”

Emails Show PhRMA Bought and Paid for ObamaCare

Remember that guy?

Well today, the Wall Street Journal reprints a series of emails showing how his administration colluded with drug-company lobbyists to pass ObamaCare. Never mind the nonsense about Big Pharma making an $80 billion “contribution” to pass the law. An accompanying Wall Street Journal editorial explains that Big Pharma “understood that a new entitlement could be a windfall as taxpayers bought more of their products.”

The money quote from these emails comes from Pfizer lobbyist/Republican/former George W. Bush appointee Anthony Principi. Even though the drug companies were donating to all the right politicians and pledging to spend hundreds of millions of dollars on pro-ObamaCare advertising campaigns and grassroots lobbying, President Obama still accused unnamed ”special interests” of trying to stop ObamaCare in order to preserve “a system that worked for the insurance and the drug companies.” Principi was indignant:

We’re trying to kill it? I guess we didn’t give enough in contributions and media ads supporting hcr. Perhaps no amount would suffice.

The nerve. I smell a campaign slogan. “Barack Obama: a Politician Who Cannot Stay Bought.”

The Journal adds:

[Former Energy and Commerce Chairman Henry] Waxman [D-CA] recently put out a rebuttal memo dismissing these email revelations as routine, “exactly what Presidents have always done to enact major legislation.” Which is precisely the point—the normality is the scandal.

And which critics have argued from the beginning. As I wrote more than two years ago, ObamaCare is corruption:

Each new power ObamaCare creates would be targeted by special interests looking for special favors, and held for ransom by politicians seeking a slice of the pie.

ObamaCare would guarantee that crucial decisions affecting your medical care would be made by the same people, through the same process that created the Cornhusker Kickback, for as far as the eye can see.

When ObamaCare supporters, like Kaiser Family Foundation president Drew Altman, claim that “voters are rejecting the process more than the substance” of the legislation, they’re missing the point.

When government grows, corruption grows.  When voters reject these corrupt side deals, they are rejecting the substance of ObamaCare.

Fortunately, voters so detest ObamaCare that there’s a real chance to wipe it from the books. This video explains how state officials can strike a blow against ObamaCare/corruption:

Blocking Obamacare Exchanges Is Only Risky for Obamacare Profiteers

USA Today reports that groups like the American Legislative Exchange Council and the Cato Institute have had much success in discouraging states from creating Obamacare’s health insurance “exchanges.” Even the Heritage Foundation, which once counseled states to establish “defensive” Obamacare exchanges, now counsels states to refuse to create them and to send all exchange-related grants back to Washington.

In response, Obamacare contractor and self-described conservative Republican Cheryl Smith sniffs:

When you work at a think-tank, it’s really easy to come up with these really high-risk plans.

Except, there is no risk to states. The only risks to this strategy are that health insurance companies won’t get half a trillion dollars in taxpayer subsidies, and that certain Obamacare contractors won’t get any more of those lucrative exchange contracts.

J.P. Morgan and Yahoo: Market Successes

Investment giant J.P. Morgan made a bad trade that cost its owners $2 billion. The responsible parties are losing their jobs. Yahoo’s CEO evidently misled people about his qualifications. As a result, he lost his job.

If you want to know why these are market successes, consider: Medicare and Medicaid lose at least 35 times as much per year to fraud and other improper payments, and Medicare wastes even more on medical care that does nothing to make patients healthier or happier. This happens year after year after year.

Now ask yourself: when was the last time someone got fired over those losses? And yet the politicians’ first reaction to the J.P. Morgan trade was greater oversight by the political system, which tolerates much greater losses than the market system that is currently disciplining J.P. Morgan.

Here’s hoping the Yahoo incident inspires some politician to crack down on people who embellish their resumes.

On Breach of Decorum and Government Growth

Last week, the Center for Democracy and Technology changed its position on CISPA, the Cyber Intelligence Sharing and Protection Act, two times in short succession, easing the way for House passage of a bill profoundly threatening to privacy.

Declan McCullagh of C|Net wrote a story about it called “Advocacy Group Flip-Flops Twice Over CISPA Surveillance Bill.” In it, he quoted me saying: “A lot of people in Washington, D.C. think that working with CDT means working for good values like privacy. But CDT’s number one goal is having a seat at the table. And CDT will negotiate away privacy toward that end.”

That comment netted some interesting reactions. Some were gleeful about this “emperor-has-no-clothes” moment for CDT. To others, I was inappropriately “insulting” to the good people at CDT. This makes the whole thing worthy of further exploration. How could I say something mean like that about an organization whose staff spend so much time working in good faith on improving privacy protections? Some folks there absolutely do. This does not overcome the institutional role CDT often plays, which I have not found so creditable. (More on that below. Far below…)

First, though, let me illustrate how CDT helped smooth the way for passage of the bill:

Congress is nothing if not ignorant about cybersecurity. It has no idea what to do about the myriad problems that exist in securing computers, networks, and data. So its leaders have fixed on “information sharing” as a panacea.

Because the nature and scope of the problems are unknown, the laws that stand in the way of relevant information sharing are unknown. The solution? Scythe down as much law as possible. (What’s actually needed, most likely, is a narrow amendment to ECPA. Nothing of the sort is yet in the offing.) But this creates a privacy problem: an “information sharing” bill could facilitate promiscuous sharing of personal information with government agencies, including the NSA.

On the House floor last week, the leading Republican sponsor of CISPA, Mike Rogers (R-MI), spoke endlessly about privacy and civil liberties, the negotiations, and the process he had undertaken to try to resolve problems in the privacy area. At the close of debate on the rule that would govern debate on the bill, he said:

The amendments that are following here are months of negotiation and work with many organizations—privacy groups. We have worked language with the Center for Democracy and Technology, and they just the other day said they applauded our progress on where we’re going with privacy and civil liberties. So we have included a lot of folks.

You see, just days before, CDT had issued a blog post saying that it would “not oppose the process moving forward in the House.” The full text of that sentence is actually quite precious because it shows how little CDT got in exchange for publicly withdrawing opposition to the bill. Along with citing “good progress,” CDT president and CEO Leslie Harris wrote:

Recognizing the importance of the cybersecurity issue, in deference to the good faith efforts made by Chairman Rogers and Ranking Member Ruppersberger, and on the understanding that amendments will be considered by the House to address our concerns, we will not oppose the process moving forward in the House.

Cybersecurity is an important issue—nevermind whether the bill would actually help with it. The leadership of the House Intelligence Committee have acted in good faith. And amendments will evidently be forthcoming in the House. So go ahead and pass a bill not ready to become law, in light of “good progress.”

Then CDT got spun.

As McCullagh tells it:

The bill’s authors seized on CDT’s statement to argue that the anti-CISPA coalition was fragmenting, with an aide to House Intelligence Committee Chairman Mike Rogers (R-Mich.) sending reporters e-mail this morning, recalled a few minutes later, proclaiming: “CDT Drops Opposition to CISPA as Bill Moves to House Floor.” And the Information Technology Industry Council, which is unabashedly pro-CISPA, said it “applauds” the “agreement between CISPA sponsors and CDT.”

CDT quickly reversed itself, but the damage was done. Chairman Rogers could make an accurate but misleading floor statement omitting the fact that CDT had again reversed itself. This signaled to members of Congress and their staffs—who don’t pay close attention to subtle shifts in the views of organizations like CDT—that the privacy issues were under control. They could vote for CISPA without getting privacy blow-back. Despite furious efforts by groups like the Electronic Frontier Foundation and the ACLU, the bill passed 248 to 168.

Defenders of CDT will point out—accurately—that it argued laboriously for improvements to the bill. And with the bill’s passage inevitable, that was an essential benefit to the privacy side.

Well, yes and no. To get at that question, let’s talk about how groups represent the public’s interests in Washington, D.C. We’ll design a simplified representation game with the following cast of characters:

  • one powerful legislator, antagonistic to privacy, whose name is “S.R. Veillance”;
  • twenty privacy advocacy groups (Groups A through T); and
  • 20,000 people who rely on these advocacy groups to protect their privacy interests.

At the outset, the 20,000 people divide their privacy “chits”—that is, their donations and their willingness to act politically—equally among the groups. Based on their perceptions of the groups’ actions and relevance, the people re-assign their chits each legislative session.

Mr. Veillance has an anti-privacy bill he would like to get passed, but he knows it will meet resistance if he doesn’t get 2,500 privacy chits to signal that his bill isn’t that bad. If none of the groups give him any privacy chits, his legislation will not pass, so Mr. Veillance goes from group to group bargaining in good faith and signaling that he intends to do all he can to pass his bill. He will reward the groups that work with him by including such groups in future negotiations on future bills. He will penalize the groups that do not by excluding them from future negotiations.

What we have is a game somewhat like the prisoner’s dilemma in game theory. Though it is in the best interest of the society overall for the groups to cooperate and hold the line against a bill, individual groups can advantage themselves by “defecting” from the interests of all. These defectors will be at the table the next time an anti-privacy bill is negotiated.

Three groups—let’s say Group C, Group D, and Group T—defect from the pack. They make deals with Mr. Veillance to improve his bill, and in exchange they give him their privacy chits. He uses their 3,000 chits to signal to his colleagues that they can vote for the bill without fear of privacy-based repercussions.

At the end of the first round, Mr. Veillance has passed his anti-privacy legislation (though weakened, from his perspective). Groups C, D, and T did improve the bill, making it less privacy-invasive than it otherwise would have been, and they have also positioned themselves to be more relevant to future privacy debates because they will have a seat at the table. Hindsight makes the passage of the bill look inevitable, and CDT looks all the wiser for working with Sir Veillance while others futilely opposed the bill.

Thus, having defected, CDT is now able to get more of people’s privacy chits during the next legislative session, so they have more bargaining power and money than other privacy groups. That bargaining power is relevant, though, only if Mr. Veillance moves more bills in the future. To maintain its bargaining power and income, it is in the interest of CDT to see that legislation passes regularly. If anti-privacy legislation never passes, CDT’s unique role as a negotiator will not be valued and its ability to gather chits will diminish over time.

CDT plays a role in “improving” individual pieces of legislation to make them less privacy-invasive and it helps to ensure that improved—yet still privacy-invasive—legislation passes. Over the long run, to keep its seat at the table, CDT bargains away privacy.

This highly simplified representation game repeats itself across many issue-dimensions in every bill, and it involves many more, highly varied actors using widely differing influence “chits.” The power exchanges and signaling among parties ends up looking like a kaleidoscope rather than the linear story of an organization subtly putting its own goals ahead of the public interest.

Most people working in Washington, D.C., and almost assuredly everyone at CDT, have no awareness that they live under the collective action problem illustrated by this game. This is why government grows and privacy recedes.

In his article, McCullagh cites CDT founder Jerry Berman’s role in the 1994 passage of CALEA, the Communications Assistance to Law Enforcement Act. I took particular interest in CDT’s 2009 backing of the REAL ID revival bill, PASS ID. In 2006, CDT’s Jim Dempsey helped give privacy cover to the use of RFID in identification documents contrary to the principle that RFID is for products, not people. A comprehensive study of CDT’s institutional behavior to confirm or deny my theory of its behavior would be very complex and time-consuming.

But divide and conquer works well. My experience is that CDT is routinely the first defector from the privacy coalition despite the earnest good intentions of many individual CDTers. And it’s why I say, perhaps in breach of decorum, things like: “A lot of people in Washington, D.C. think that working with CDT means working for good values like privacy. But CDT’s number one goal is having a seat at the table. And CDT will negotiate away privacy toward that end.”