Ouch.

I’m anything but an expert on British politics, but if the head of the Conservatives is making noises like this, we’ve got a serious image problem abroad:

“I and my party are instinctive friends of America and passionate supporters of the Atlantic alliance,” [Conservatives chief David Cameron] said, warning against the “intellectual and moral surrender” of anti-Americanism. But he added that being an uncritical ally was dangerous for Britain: “I fear that if we continue at present we may combine the maximum of exposure with the minimum of real influence over decisions.”

Risking a rift with the Republicans and his own traditionalists, he attacked the “unrealistic and simplistic” neoconservative philosophy of Mr Bush’s closest colleagues and advisers, calling it “a view which sees only light and darkness in the world – and which believes that one can be turned to the other as quickly as flicking a switch”.

Health Care Quality: Sharpening the Differences

Ezra Klein wants patients to receive the highest quality health care possible.  So do I.  Klein thinks that patients are “easily fooled” when it comes to health care quality.  So do I.  Klein thinks “panels of experts should watch over health care decisions.”  So do I. 

Klein thinks that politicians should empanel and watch over those experts.  I think that multiple panels should compete to provide patients with the best information, which patients could take or leave.

I worry that if politicians lead the pursuit of quality, the pursuit of quality will become infected by politics.  Klein kind of agrees.

Klein proposes to get around that sticky wicket by prohibiting Americans from contributing to politicians they like.  I think it’s an odd health care agenda whose success requires shredding the First Amendment.

Klein thinks patients are ignorant about quality, and thinks politicians should insulate patients from the costs of their medical decisions.  I think insulation from costs breeds ignorance about quality.

An elderly woman presents with abdominal pain from ingesting a spider.  Klein’s prescription: one bird and one cat, to be administered orally.  Cannon’s prescription: induce vomiting.

David Brooks’ Newest Conservatism

At various times, David Brooks has called his political philosophy “neoconservatism,” “compassionate conservatism,” “national greatness conservatism,” “big government conservatism” and, now, “progressive conservatism.” By any name, however, it has one common denominator: big, expensive, and intrusive government. In Sunday’s New York Times, Brooks puts forward a plan for “human capital investment,” calling for:

  • Giving every child born in America $1,000 at birth to put in a savings account;
  • Spending more money on preschool;
  • Further extension of the Earned Income Tax Credit;
  • More government reorganization of our educational system; and
  • An increase in the child tax credit.

Actually, there is a term for this type of program—it’s called liberalism.

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Goldwater on Goldwater on HBO

Next Monday, September 18, HBO will broadcast a new documentary, “Mr. Conservative: Goldwater on Goldwater.” The film was made by Barry Goldwater’s granddaughter, CC Goldwater. The Los Angeles Times calls it “an unabashedly admiring — though not wide-eyed — attempt to reclaim her grandfather’s legacy, and to reconcile the man she adored — the avid gadgeteer, ham-radio operator, aviator, and truly talented photographer of American Indians — with the controversial political figure, often heralded as the father of the American conservative movement.”

There are three kinds of people these days who like to call themselves “Goldwater Republicans”:

* libertarians, who tend to ignore the social conservatism of the senator’s 1964 presidential campaign, focusing on his rugged-individualist opposition to the federal leviathan and his later opposition to the religious right;

* liberals, who would perhaps have been Rockefeller Republicans in 1964, when they denounced Goldwater as literally insane; and

* limited-government conservatives, who still believe in the ideals of Goldwater’s book The Conscience of a Conservative and regret the big-government conservatism that now dominates the Republican party.

My guess is that “Goldwater on Goldwater” is going to appeal more to the first two groups than to the actual Goldwaterites. It interviews people from across the political spectrum, but George Will appears to be the only Goldwaterite interviewed, while it also features Hillary Rodham Clinton, Teddy Kennedy, Ben Bradlee, Walter Cronkite, Al Franken, and James Carville. Interviews with the daughter who had an abortion and the gay grandson also indicate a strong emphasis on the later Goldwater.

Either way, spending 90 minutes with Barry Goldwater has got to be a welcome respite from the world of George W. Bush.

New England Journal of Medicine Reviews Crisis of Abundance

Arnold Relman reviews the Cato Institute’s latest health policy book, Crisis of Abundance by adjunct scholar Arnold Kling, in the latest issue of the New England Journal of Medicine. Dr. Relman is a former editor of the NEJM and an advocate of socialized medicine. Nonetheless, he compares Kling favorably to other economists who write about health care:

[Kling] has done a much better job than most of his colleagues. His book is clear, concise, and eminently readable; he writes in straightforward English prose, not economic jargon; he is modest, posing questions more often than he answers them; and he considers alternatives to most of the policy options he discusses.

Many readers will know that I am a longstanding critic of the economic approach to health care policy, but I liked this little book and can recommend it highly…

I was attracted by a certain freshness and directness in much of Kling’s argument, and I found myself agreeing with many of his observations…

[Kling] intends only to “raise the level of understanding of the realities, issues, and tradeoffs pertaining to health care policy.” I think he succeeds pretty well at that, so I warmly recommend his book to general readers who want to understand what economics has to say about health care.

NEJM subscribers can click to the full review from here. We expect to be able to link to the full review soon from http://www.cato-at-liberty.org/ and http://www.cato.org/.

Crisis of Abundance is available for purchase here.

GAO Report on HSAs

I just received an e-mail notice from the GAO about a report issued last month on health savings accounts. From my cursory read, the report doesn’t seem to contain anything unpredictable or earth-shattering. Corroborating that impression is the fact that I cannot find where Sen. Max Baucus (D-MT) — a longtime HSA opponent who commissioned the study from the GAO — has released any statement on it. (The GAO doesn’t release its reports until a couple of weeks after it delivers them to the congress-critter who made the request. That lets congress-critters be the first to spin release any GAO report.)

In all, the report brings to mind an observation by the Congressional Research Service that I included in a recent paper on HSAs:

Some less healthy people may find HSA plans attractive because they enable them to circumvent the restrictions of managed care plans. Conversely, some healthy people may find them unattractive because they are very risk-averse; they would prefer to pay more for comprehensive insurance with low deductibles. Older people may find HSA plans attractive because of the tax advantages: being in higher tax brackets (since average earnings increase with age until people are in their 50s), their tax savings from contributions would be greater. People who are 55 but not yet 65 years of age would also be attracted by the additional catch-up contributions they may make. By the same token, younger people with low incomes may consider the HSA tax advantages inconsequential.

The GAO seemed to find that HSAs worked for some people, and not for others. In their current incarnation, HSAs may not be for everyone. But the GAO’s findings hardly tracked the fear-mongering of HSA opponents. Some quotes from the report:

  • “HSA-eligible plans constitute a small but growing share of the private health insurance market.”
  • “[A] 2005 national employer health benefits survey reported HSA-eligible plan premiums that were, on average, 35 percent less than traditional plan premiums for single coverage and 29 percent less for family coverage.”
  • “[A] 2005 national employer health benefits survey reported HSA-eligible plan premiums that were, on average, 35 percent less than traditional plan premiums for single coverage and 29 percent less for family coverage.”
  • “The HSA-eligible plans offered by the three employers we reviewed covered the same broad categories of health care services as did traditional plans in 2005, including preventive, diagnostic, maternity, surgical, and emergency services, and also used similar provider networks.”
  • “HSA-eligible plan enrollees generally had higher incomes than comparison groups, but data on age differences were inconclusive.”
  • “IRS data…suggest that the average age of tax filers who reported HSA contributions was about 9 years higher than the average age of all tax filers under age 65 in 2004…. In contrast, data from several employer groups indicate that the average age of HSA-eligible plan enrollees, excluding retirees, was 2 to 6 years lower than that of other groups of enrollees.”
  • “While focus group participants enrolled in HSA-eligible plans understood the key attributes of their plan, such as low premiums, high deductibles, and the mechanics of using the HSA, they were confused about certain other features. For example, many participants were unsure what medical expenses qualified for payment using their HSA.”
  • “Few participants researched the cost of hospital or physician services before obtaining care, although many participants researched the cost of prescription drugs.”
  • “Most participants reported satisfaction with their HSA-eligible plan, but said they would not recommend these plans to everyone. Participants said they would recommend HSA-eligible plans to healthy consumers, but not to people who use maintenance medication, have a chronic condition, have children, or may not have the funds to meet the high deductible.”

I have argued that requiring people to have a rigidly defined high-deductible health plan in order to qualify for an HSA is unnecessary, and probably does more than anything to make HSAs unattractive to many consumers. 

I have also recommended expanding HSAs to give workers control over every one of their health care dollars, and to allow workers to purchase any type of health insurance they wish.

How Dare You Support Those Who Agree with You!

The New York Times is generally recognized at the nation’s newspaper of record, and rightly so. Times reporting typically is broad, in-depth, nuanced, and thoughtful. It should be on everyone’s daily reading list.

But the Times sometimes allows its general excellence to be interrupted by yellow journalism, as exemplified by today’s prominent article describing (and implicitly decrying) contributions made by the Walton Family Foundation to several public policy groups whose scholars have written or spoken in support of various Wal-Mart practices.

(In the interest of full disclosure, Cato was not mentioned in the article. I have no idea whether Cato receives any contributions from the Walton Family Foundation.)

The upshot:

[T]he financing, which totaled more than $2.5 million over the last six years, according to data compiled by GuideStar, a research organization, raises questions about what the research groups should disclose to newspaper editors, reporters or government officials.

Curiously, buried deep in the article, is this little nugget:

Conservative groups are not the only ones weighing in on the Wal-Mart debate. Ms. Williams of Wal-Mart noted labor unions have financed organizations that have been critical of Wal-Mart, like the Economic Policy Institute, which received $2.5 million from unions in 2005.

In response, Chris Kofinis, communications director for WakeUpWalmart.com, an arm of the United Food and Commercial Workers Union that gives money to liberal research groups, said: “While we openly support the mission of economic justice, Wal-Mart and the Waltons put on a smiley face, hide the truth, all while supporting right-wing causes who are paid to defend Wal-Mart’s exploitative practices.”

So, the New York Times gives the scandal treatment to the Walton Family Foundation’s handing out a little over over $400,000 a year to a bunch of public policy groups that write favorably about Wal-Mart, but barely acknowledges that anti–Wal-Mart forces gave out $2.5 million in just one year to just one group that criticizes Wal-Mart. And the Times lets the leader of one of those anti–Wal-Mart groups give a hammer quote decrying think tanks as Wal-Mart hacks.

What’s most disappointing is that the Times didn’t give any consideration at all to what should have been the fundamental question of the article: Is there merit to the pro–Wal-Mart arguments made by think tanks that receive Walton money? Or, are those arguments flawed, suggesting their authors may have been influenced by the Walton money?

The Times article is, in essence, a pathetic ad hominem attack.

And that is a ridiculous failure for a newspaper as fine as the Gray Lady.

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