I Challenge Paul Krugman to a Debate on SCHIP

Democracy NOW! quotes New York Times columnist Paul Krugman on the State Children’s Health Insurance Program:

the reason that Bush and much of the Republican leadership is so hostile to S-CHIP is not because they think it’s a bad program, but because they think it’s a good program, and that terrifies them. What bothers them so much is the fact that it works.

Why does Krugman think that SCHIP “works”? There is no evidence that the program is a cost-effective way of improving child health. It makes health care more expensive for those outside the program. It does not address the systemic problems that lead to low-quality pediatric care. It reduces the benefits of education and work effort, trapping families in low-wage jobs. It covers four uninsured children for the price of ten

Krugman is an economist. Has he thought about these issues? Has he read any of this literature? What about this program “works”?

It’s easy to dismiss right-wing hacks. These issues … not so easy to dismiss.

How to Argue against SCHIP

I like to open with this: “If your goal is to improve the health of low-income children, the State Children’s Health Insurance Program is a bad tool for achieving that goal.”

Then I make as many of the following points as possible.

  1. SCHIP does a bad job of targeting assistance. About 60 percent of children currently eligible for SCHIP already have private health insurance, while 77 percent of those targeted by this expansion (i.e., children between 200-300 percent of the federal poverty level) already have private health insurance.
  2. SCHIP covers four uninsured children for the price of ten. Economists Jonathan Gruber and Kosali Simon estimate that, in effect, 60 percent of children covered by SCHIP expansions already had private coverage.
  3. There is no evidence that SCHIP is the best way to improve the health of targeted children. Economists have found no evidence that SCHIP is a cost-effective way of improving health. Discrete health programs or policies that improve incomes or education could deliver as much or more health for the money.
  4. SCHIP discourages families from climbing the economic ladder. If a single mother of two earning minimum wage in New Mexico increases her annual earnings by $30,000, she pays an additional $4,000 in taxes and loses $26,000 in SCHIP and other government benefits. In other words, her net income would not change, therefore she has no financial incentive to climb the economic ladder. Expanding SCHIP would put downward pressure on even more families’ incomes, which could harm child health.
  5. Like Medicaid, SCHIP makes private coverage less affordable for people outside the program. Under Medicaid (and therefore SCHIP) rules, the government agrees to pay a percentage of what drug makers charge private payers. Economists have found that manufacturers respond by raising prices for private purchasers an estimated 15 percent.
  6. SCHIP would do nothing to address systemic quality problems. According to a recent study in the New England Journal of Medicine, “Expansion of access to care through insurance coverage, which is the focus of national health care policy related to children, will not, by itself, eliminate the deficits in the quality of care.”
  7. SCHIP’s self-interested advocates. Why do you suppose the physician, pharmaceutical, and health insurance lobbies are agitating for health care subsidies that lack any evidence of cost-effectiveness?
  8. This SCHIP expansion taxes the poor to benefit the middle class. Isn’t that just cruel?
  9. Eliminating SCHIP and letting people purchase coverage from out-of-state is a better alternative. The latter would enable families to avoid unnecessary regulatory costs, which the Congressional Budget Office puts at about 15 percent of health premiums. That would benefit SCHIP-targeted families most of all. And it would do so without raising anyone’s taxes, showering subsidies on non-needy families, pulling families into a low-wage trap, or increasing the cost of private insurance. As for eliminating SCHIP, when Congress cut non-citizen immigrants from the Medicaid rolls, contrary to all predictions the number of uninsured non-citizen immigrants actually fell. Why wouldn’t SCHIP families, who are more affluent, fare even better?

Then I like to close with this: “If you’re not interested in the best way to promote child health, not interested in targeting government assistance to the needy, and not concerned about trapping families in low-wage jobs…exactly what is it you are hoping to accomplish?”

Here [audio file] is what happened after I made just a few of these points to left-wing talk show hostess (and frequent Alan Colmes stand-in) Leslie Marshall.

Friendly Advice for Conservatives on Health Care

National Review Online’s Health Care Week is in full swing. The site features a week’s worth of essays on how conservatives should approach health care.

My contribution offers friendly advice about how conservatives can avoid abetting the Left as well as the special interests who profit from the creeping socialization of American health care:

Health care is a tough issue for conservatives only because they have strayed from their free-market principles. When conservatives return to those principles, health care will again become a tough issue for the Left.

It was the most fun I’ve had with an oped in a while. Read the whole thing here.

Disaster Collectivism

Naomi Klein, darling of the loonie left, has a new book out called The Shock Doctrine: The Rise of Disaster Capitalism. The basic idea is that the insidious forces of neoliberalism take advantage of wars, economic crises, and natural disasters to impose their evil schemes on disoriented and distracted publics. The career of Milton Friedman, the occupation of Iraq, and the bungled response to Katrina are all supposedly cases in point.

Klein is not a serious person, and in this book she does not mount a serious argument. But she does raise an interesting issue: the political implications of crises. It is certainly true that the waves of liberal reform (political as well as economic) that swept the world in the ’80s and ’90s were often triggered by economic crises. Indeed, I wrote a book on the subject in which I interpreted the current episode of globalization as a response to the often cataclysmic breakdown of various state-dominated models of economic development.

There’s nothing terribly surprising about this. Inertia is a powerful force in politics: every status quo has vested interests that benefit from it, while advocates of change push in all different directions and frequently cancel each other out. A crisis, though, can discredit the status quo and demoralize its supporters, while galvanizing particular pro-reform camps and boosting their credibility. Politics suddenly becomes more fluid; rapid and sweeping changes that had no chance of being enacted beforehand now occur in rapid succession.

But it’s ridiculous to portray this dynamic as somehow uniquely favoring one side of the political spectrum. Recall the great triumphs historically associated with the left: the French Revolution was made possible by the financial distress of the ancien regime; the Paris Commune was founded after defeat at the hands of the Prussians; the Russian Revolution was catalyzed by military failures in World War I.

In our own country, it was a one-two punch of cataclysms – the Great Depression, followed by World War II — that brought Big Government to the United States and then consolidated its hold. The unprecedented economic collapse made traditional American attitudes of laissez faire and individual responsibility seem hopelessly outdated; by contrast, the frenetic activity of the New Deal, regardless of the decidedly mixed results, projected boldness and vigor and hope. The subsequent mass mobilization for total war reinforced the shift in political culture. If you watched any of the wonderful new Ken Burns documentary on “The War,” you saw that the “home front” wasn’t just an expression: the diversion of the country’s industrial might to war production, price controls and rationing, extremely high tax rates, war bond drives, and incessant propaganda combined to thoroughly collectivize American society. And it worked: the economy boomed, people reaped the psychological satisfactions of banding together against a common and abominably evil enemy, and in the end America triumphed.

Today people on the left are filled with nostalgia for the political economy of the early postwar decades. I don’t think many of them recognize, though, how heavily their Golden Age depended on the lingering economic and cultural effects of destruction on a mind-boggling scale. They call themselves progressives, yet they pine for the good old days of disaster collectivism.

[cross-posted from www.brinklindsey.com]

Catholics against SCHIP

The Rev. Robert A. Sirico is a Catholic priest, as well as president and co-founder of the Acton Institute for the Study of Religion and Liberty.  In today’s Detroit News, he weighs in on the debate over the State Children’s Health Insurance Program:

The Catholic Health Association has blasted President Bush for vetoing a program called SCHIP, the State Children’s Health Insurance Program. How can anyone be against the health of children?

Well, public policy is more complicated than that. When the state gets involved in public health, there are unintended consequences. In fact, there is enough wrong with this program to make it possible to oppose SCHIP in good conscience…

There is not a living soul who would not wish that every person, especially every child, would have access to perfect medical care. But the essential condition for universal coverage is universal prosperity, and the only means available to create that is a flourishing and free economy – a condition that programs like SCHIP help to undermine…

It is folly to seek short-term gains at the expense of long-term economic development. Eliminating taxes and regulations that hinder private industry will make greater strides toward universal coverage than any state program can or will…

What I fear most is that politicians use legitimate issues to gather more power unto themselves and their friends in government. The population becomes more dependent on the public sector and less reliant on the sectors over which they exercise real control.

Amen to that.  Now how do we get the Catholic hospitals to stop taking Caesar’s coin?

Five Years On — It’s (Well Past) Time to Make a Choice

Today’s Washington Post op-ed by 12 Army captains who served in Iraq is a sobering but welcome contribution to the voluminous literature on what went wrong in Iraq, and what we should do next. The entire article is worth reading, but the concluding paragraphs boil down the essential points:

There is one way we might be able to succeed in Iraq. To continue an operation of this intensity and duration, we would have to abandon our volunteer military for compulsory service. Short of that, our best option is to leave Iraq immediately. A scaled withdrawal will not prevent a civil war, and it will spend more blood and treasure on a losing proposition.

America, it has been five years. It’s time to make a choice.

This is how the debate over Iraq should have been framed at the outset – before Congress voted to grant the president authorization to use force.

Success in Iraq was always uncertain. How uncertain depended, in part, on the amount of effort we were willing to exert in the endeavor; but it also depended on a number of factors well beyond our control. And there is no evidence that George Bush ever seriously contemplated the costs of waging war for five years – he merely asserted on the eve of war that the costs of inaction outweighed the costs of action.

For a time, the American public went along. Now, five years on, a solid majority disagree. In poll after poll, Americans say that the costs that we have already paid in this war far exceed whatever benefits we might hope to derive from it. And they are looking to cut our losses.

They are unlikely to embrace a further escalation of the conflict, particularly one that entails the draconian step of reinstituting the draft. And they should not do so. As the Army captains concede, we might still fail, even if we flood Iraq with tens or hundreds of thousands more American troops. Hardly a ringing endorsement for that option.

If our national survival hung in the balance, if our very existence was threatened by an escalating civil war in Iraq, we would be spared such discussions: we would invest what was necessary, and worry about the consequences later.

But Iraq always was, and always will be, a war of choice. We should choose to terminate the mission, and refocus our attention – and, where appropriate, our still-strong military – on the enemies who struck us on 9/11.

That the choice is clear does not imply that the choice is easy. The ramifications of a U.S. withdrawal are likely to be horrible in the short term, especially for the many Iraqis who risked their lives by cooperating with the American forces, and the many more who are likely to be caught in a worsening civil war. We should do what we can to help the Iraqis, especially those who have helped us.

There are still other concerns. The real risk of that civil war spreading beyond Iraq’s borders, actions that could spawn a wider regional conflict, requires that a U.S. military withdrawal be combined with a diplomatic offensive to encourage all of Iraq’s neighbors to take prudent steps to contain the violence. Our problem is also their problem; they would be wise to cooperate with us, and with each other, to prevent a far worse catastrophe from unfolding there.

But such considerations do not change the basic calculus for the United States: given that we should not be willing to pay whatever might be needed to win, recognizing all the time that victory is uncertain, and might take years to achieve, we should leave.

I commend these 12 soldiers for their service in Iraq; and, although it can’t compare to their courage and sacrifice over there, I commend them for weighing in on the issue.

Surveillance and Doublespeak

The Washington Post has a story today about the government’s data collection activities. Unfortunately, the article repeatedly says the FBI is “requesting” information from the phone companies. That’s misleading. The FBI is using subpoenas and national security letters. Thus, federal agents are demanding information from the businesspeople. A refusal to comply means fines and jail. This is an area of law and policy that needs much more attention.