July 14, 2006 9:50AM

Medicare Reform: Just Give Seniors the Cash

Matthew Holt at TheHealthCareBlog.com raises a good question about Medicare's renewed effort to offer medical savings accounts to beneficiaries:

Those taxpayers who can do basic math might wonder why you’d want to to give healthy Medicare beneficiaries cash for health services that they’re not going to use, while taking that cash away from the pot that pays for the sick beneficiaries that do use said services. But we’ve asked that question so many times before and no one on the free market side dare answer it. And I guess you might say, why not give the taxpayers money straight to the “healthys” instead of laundering it through Medicare Advantage plans as we’re doing it now so that they can hand out free gym memberships to seniors and boost their executives’ stock holdings.

But given that risk adjustment is coming to Medicare Advantage, it may be that that gravy train is ending.

The Medicare MSA concept raises some interesting problems. Fortunately, Holt solves them — though I'm not sure he knows it.

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July 13, 2006 4:18PM

Have We Learned Nothing from “SchoolHouse Rock”?

"I'm just a bill, yes I'm only a bill, and I'm sittin' here on Capitol Hill..."

Back when dinosaurs roamed the earth and cartoons were confined to Saturday morning broadcast programming, kids learned about the separation of powers (among other things) from the "SchoolHouse Rock" toons.

Apparently some future New Jersey lawyers weren't tuned in.

The recent lawsuit about which Cato's Neal McCluskey has been writing asks the court to create a school voucher program in New Jersey as a remedy to the state's deficient public school system. Right ends, wrong means. Courts are for legal interpretation; legislation is for legislatures.

There's little doubt that New Jersey is failing to live up to its constitutional promise to provide a "thorough and efficient" education. Should the court so rule, it will be up to the legislature to fix the problem, and introducing a universally accessible free education marketplace is certainly the best solution they could implement.

But it's their job to implement it, not the court's.

July 13, 2006 11:17AM

The Answer Is: “Public School Establishment”

Yesterday, I wrote about a New Jersey lawsuit aimed at letting parents with children in failing public schools take their children, and their share of public education funding, and send them to any institution they want, public or private. It’s a new twist on educational equity suits all over the country that have produced a ton of new funding for supposedly poor districts, but little by way of academic success.

At the end of yesterday’s post, I wondered aloud whether long-time supporters of old-style equity remedies would get behind litigation intended to empower parents, or if they would only support suits that would shower more money on “the public school establishment.” I mentioned specifically the Education Law Center, which has been the driving force behind old-school equity cases in New Jersey for decades.

This morning, in a story about the disastrous Camden, NJ, public schools, I’m afraid I got my answer:

Camden schools -- despite their ongoing problems -- have taken positive steps by offering preschool programs, reducing class size and other efforts, said David Sciarra, executive director of the Education Law Center.

"It's easy to criticize and have some silver-bullet solution that's untested and unproven," Sciarra said. "There's a positive agenda that we need everyone, including the school-choice activists, to get behind."

I suppose I could hope that when Sciarra attacked a “silver-bullet solution that’s untested and unproven” he was referring to pouring more and more money into improvement-invulnerable public schools, but that’s been tested repeatedly…and constantly found to be a failure. Unfortunately, I guess that means I have my answer.

July 13, 2006 9:35AM

The Spin on Medicaid

The Administration claimed this week that Medicare and Medicaid spending has slowed, but a close look at the overall picture tells a different story. My colleague Michael Cannon has already posted his opinion about Medicare spending.  Here’s the low-down on Medicaid.

The official spin:

Medicaid cost projections are once again declining, reflecting ... a slowdown in Federal Medicaid spending growth from over 12 percent per year in fiscal year 2000-2002 to 7.2 percent from 2002-2005, down further to 4.6 percent projected for fiscal year 2006-2007.

And the complete story:

Summary budget tables -- updated during the release of the Administration’s Mid-Session Review of the Budget this week -- indicate that federal Medicaid and SCHIP (State Children’s Health Insurance Program – also a part of Medicaid) outlays would grow from $129 billion in 2001 to $213 billion by 2008.  That’s a cumulative (geometric) annual average growth rate of 7.7 percent during the Administration’s full tenure.  The nation’s Gross Domestic Product, on the other hand, would grow at a much slower pace -- just 5.2 percent per year during the same period.

Much of Medicaid spending growth resulted from the substantial surge in enrollments and benefits per enrollee during the aftermath of the 2001 recession.  Medicaid outlays would be expected to surge during recessions but should abate when growth picks up.  The latter did not occur during the 1991 and 2001 recession episodes.  During the later recession, changes in federal regulations made it easier for states to expand coverage to broader groups and claim federal matching grants against such coverage.  And evidence from micro-data surveys indicates that it was not the poorest groups that received most of the latest increases in Medicaid coverage and benefits.

The reasons for the current slower growth in Medicaid spending are the transfer of the fastest growing prescription drug coverage to Medicare and robust economic growth.  However, according to the Administration’s projections, faster Medicaid spending growth – at 7-plus percent per year -- is projected to resume after 2007.

Providing greater power to states to redesign their programs while persisting with a federal financing mechanism of matching grants (rather than block grants with capped growth) promotes states’ incentives to spend more. That will cause…you guessed it…more spending on our middle-class Medicaid entitlement.

July 13, 2006 9:21AM

Vanuatu: Islands of Fire or Heaven on Earth?

There is an egregiously dumb "study" out today that reports that Vanuatu---best known as a place to hide money from the taxman and the site of "Survivor: Vanuatu - Islands of Fire"---is the world's happiest country. The real travesty is that this study is being reported by reputable news outlets as if it wasn't just the product of a few ideologues making stuff up. Bloomberg's headline says, "Vanuatu, Pacific Islands, Lead U.S., World in Happiness Ranking." UPI's headline reads, "Pacific's Vanuatu 'happiest country'." Sounds sort of official, no? Here's the start of the Bloomberg article:

Vanuatu, a group of South Pacific islands populated by fisherman and farmers, is the world's happiest place, according to a study published today.

The U.S. and U.K. are among the world's least happy countries because of their higher consumption of natural resources such as oil, according to an index compiled by the New Economics Foundation, a London-based researcher. The biggest malcontents were in Zimbabwe, ranking bottom.

So, if you consume oil, you are therefore unhappy? Who is this New Economics Foundation? What's the methodology here? Bloomberg:

The New Economics Foundation is a research group that organizes campaigns on environmental and economic issues such as debt relief. It was set up in 1986 to question the agenda of the Group of Eight leading industrialized nations.

The Happy Planet Index covers 178 countries by multiplying life expectancy by life satisfaction, and dividing it by environmental impact in each country, including carbon emissions. The index was compiled over two months, using United Nations life expectancy figures from 2003, World Database of Happiness statistics from 2005 and the World Footprint Network's research on consumption and environmental impact.

The NEF from this description looks to my jaundiced eye like a front for hyper-ideological activists out to oppose the creation of wealth. Maybe they are. But they also have a very nice website. And they have partnered with the Office of the Deputy Prime Minister in the U.K. So maybe editors are duped by the luster of intellectual legitimacy.

But really! Multiply life expectancy by life satisfaction and divide it by environmental impact? That is, to be over-charitable, completely arbitrary. This is an index of, at best, the New Economic Foundation's ideological preferences. It is a totally intellectually vacuous product meant to garner headlines, and it worked, to the shame of the Bloombergs and UPIs of the world.

Furthermore, it cheapens the work of real social scientists attempting to measure happiness and well-being. I worry that much of the happiness work is ideologically loaded, but most of it is at least an honest attempt study human welfare empirically. Too much of it, however, is stuff like the NEF's index, basically an attempt to persuasively define something like "happiness" so that it comports with a statist, anti-growth agenda. This is sheer politics brazenly posturing as social science. If the Cato Institute published a study that, say, mutliplied life satisfaction by the rate of economic growth and then divided it by government spending as a percentage of GDP, and called it "The Happy World Index, " would editors think twice? I hope they would. In fact, I bet they would. So why did this trash get through the filter?

The NEF is no doubt ideologically irritated by the fact that, say, carbon emissions per capita and reported life satisfaction are positively correlated. Here, for illustration, is a graph from Nation Master. If you're concerned about "environmental impact" why not divide life satisfaction by life expectancy? Dead people don't use fossil fuels!

More seriously, the NEF's program to define wealth, happiness, and progress along their narrow ideological lines is an attempt to circumvent serious debate about human well-being by building substantive judgments about the relative priority of competing values into the project of measuring things we all care about. It's a too-easy trick to simply define "happy" as whatever it is you think is important, and then show that places that best exemplify what you think important are the "happiest" ones. They present it as a significant finding that "Self appointed world ‘leaders’ – the G8 - score generally badly in the Index." But they designed it so that the world's wealthiest countries would come out poorly. Yes, the most productive economies use the most energy. But that doesn't get headlines. This sort of thing does not advance human knowledge one iota. It's certainly not newsworthy.

By the way, a denizen of Vanuatu can expect to live a full decade less on average than an American. And GDP per capita there is $3,346 a year, compared to $41,399 in the U.S. Now, the happiness data show very clearly that self-reported happiness increases sharply as a function of income up to around $10-$15,000 a year, when it begins to level off. I can't actually find data for Vanuatu in the World Database of Happiness, the cited source. But unless the Islands of Fire is a massive outlier, Vanuatuans could become significantly happier by tripling or quintupling their wealth. Becoming happier by becoming wealthier---by growing the size of the surplus from economic cooperation---would very likely require an increase in Vanuatu's energy use, and that would cause them to plummet down the NEF index. (It must be admitted, however, that the Vanuatu Statistic Office has a truly awesome website. Welcome to 1997!)

NEF is selling a "sustainable development" agenda. The point they'd really like to get in the papers from their study is this: "Overall, we are over-burdening the Earth’s currently available biocapacity," which is a bit surprising in a study ostensibly about happiness. Now, sustainable is good and unsustainable is bad, but the biocapacity stuff is mostly nonsense. I guess they needed a "new economics" because the old economics didn't fit their agenda. For an "old economics" tonic, check out Jerry Taylor's excellent 2002 paper, "Sustainable Development: A Dubious Solution in Search of a Problem." Here's a snippet from the abstract:

[T]he fundamental premise of [sustainable development]—that economic growth, if left unconstrained and unmanaged by the state, threatens unnecessary harm to the environment and may prove ephemeral—is dubious. First, if economic growth were to be slowed or stopped—and sustainable development is essentially concerned with putting boundaries around economic growth—it would be impossible to improve environmental conditions around the world. Second, the bias toward central planning on the part of those endorsing the concept of sustainable development will serve only to make environmental protection more expensive; hence, society would be able to "purchase" less of it.

Or look at Jerry's Julian Simonesque essay "The Growing Abundance of Natural Resources":

That [overburdening or "overshooting"] argument, however, is in direct contradiction to every possible measurement of resource scarcity and the march of recorded history. If overshoot occurs when we use resources faster than they are created by nature, then the world has been in accelerating "overshoot" for the last 10,000 years, or ever since the development of agriculture. Moreover, our best "feedback" on scarcity---market prices---tells us that resources are expanding, not contracting.

There is simply no non-crazy sense in which Vanuatu is the world's happiest country. And there is no credible empirical reason for docking countries on any kind of index of human well-being for producing a lot of wealth. The evidence says that the happiness of poor populations like Vanuatu's would skyrocket with swift economic growth. But growth is exactly what NEF is trying to limit. Their pseudo-study encourages us to be complacent about the poverty of Vanuatu, which is, after all, the "happiest" place on our "happy planet," on the basis of the fact that they use almost no energy. If you really care about the well-being and happiness of the world's poor, then agressively misleading publicity stunt studies like this one, and the people who author them, deserve nothing but our scorn.