Bad news: the House has just passed the farm bill by a veto-busting margin of 318 to 106. Roll call here. The measure will likely become law unless the improbable happens and scores of Republicans back up the president’s veto when it comes.

Yesterday, an announcement from the Commonwealth Fund landed in my inbox. The subject line read:

How to Achieve Universal Coverage While Lowering Health Spending

A colleague received the same release, and forwarded it along with this note:

Coming next, anti-gravity and perpetual motion machines.

To which I replied:

…eternal youth, gold from base metals, a lasting peace in the Middle East…

To which he replied:

The dead shall rise, the lame shall walk, the blind shall see.

I’m tempted to throw in something about the Cubs winning the World Series. But even that wouldn’t convey the level of impossibility we’re talking about here. You see, there’s an outside chance that the Cubs actually could take the Series.

I’d say we’re as likely to see the dead, the lame, and the blind win the World Series as we are to achieve universal coverage while lowering health spending.

Or does even that overstate the odds?

After noting that “some of my best friends work for think tanks,” The Atlantic blogger Megan McArdle contends that these organizations cannot be trusted because the purported ideological homogeneity of their employees renders them intellectually blindered, lazy, and compromised. Since Cato was apparently the first think tank Ms. McArdle thought of in the context of school choice (and I’m not even one of her best friends!), I couldn’t resist the temptation to respond.

All human institutions are flawed (I used to work for one of the most successful corporations in the world, and it was no exception), but I haven’t noticed the crippling “groupthink” that McArdle warns of in my time at Cato. I have had stimulating debates with colleagues on a host of issues, including education policy. As it happens, I’m not alone. Cato made waves in the blogosphere not so long ago due to a very public disagreement among its staff over domestic surveillance law and policy. One of the bloggers who noted this lack of ideological groupthink at Cato was… Megan McArdle. Cato scholars have at times publicly disagreed on high profile foreign policy questions as well.

Getting to the heart of her argument, though, I’m puzzled as to why someone conversant with public choice theory would imagine that think tanks are categorically different from other sources of scholarship when it comes to ideological bias. McArdle contends that donors would balk if think tanks produced publications at odds with the donors’ preferences. Some do. Cato has in fact lost donors on a number of occasions for this reason. But this incentive system is not fundamentally different from what obtains in the academic world. In academia, career advancement is tied to journal publication, but journal editors and peer reviewers have their own biases (as do academic authors themselves), and these are felt in their decisions of what to publish. Hence, there is pressure on academics to conduct studies they expect to be more rather than less publishable.

The most notable difference between academic and think tank papers is that naive some readers grant academic papers an unwarranted presumption of impartiality. The same applies to government publications. For think tanks, the absence of that presumption means that our work is more stringently checked by the media when the ideological flavor of the medium is different from the presumed slant of the think tank. Since there are few libertarian media outlets, Cato output is subjected to more extensive fact checking by the media than is the typical academic paper, government pronouncement, or the media’s own reporting. For example, I recently wrote an op-ed noting that the press grossly understates per pupil spending in DC public schools. In making my case, I observed that local media had claimed “$8,322 is spent for each student” and then I showed that when the district’s total budget is divided by its enrollment the real figure is over $24,000 per pupil. The editor of the paper publishing my piece asked for my source for the inaccurate media figure, claiming that his own paper knew better. I pointed him to an article in his own paper that used it (among others).

This is not unusual. It is far more common that we at Cato point out inaccuracies in the mainstream media and in government claims and reports than the other way around. 

In a world in which everyone who collects and analyzes data invariably is subject to complex economic pressures, there is only one reliable path to the truth: read their publications critically and assess them for yourself, on their intrinsic merits. In cases where you lack the expertise to critically evaluate a study yourself, the next best thing is probably to seek out a proxy reviewer — an expert in the field whose conclusions you have reason to trust. But simply dismissing an entire category of scholarly institutions due to a misplaced faith in the impartiality of the other categories is an epistemological error.

In an op-ed in today’s Wall Street Journal the political liberal Thomas Frank paints a Depression-era picture of American workers and households.

“Real hourly wages for most workers … have risen only 1% since 1979,” he writes. Median “non-elderly” household income is down since 2000. Americans work more hours per year than their counterparts in other industrialized countries. The phrase “modern American slave labor” even finds its way into his column. All this reminds Frank of “those what-if stories in which Hitler wins World War II. Could this really have happened to my country?”

What is to blame for this “disaster”? According to Frank, “tax cuts, trade agreements, deregulatory measures, and enforcement decisions all finely crafted to benefit one part of society and leave the rest of us behind.”

Facts on the ground show a far different America. In a study from last October, titled “Trading Up,” I found that expanding trade and trade agreements have actually lifted the living standards of most Americans. Consider a few facts that directly contradict Frank’s doom-saying:

• In the past decade, the average hourly real compensation—wages and benefits adjusted for inflation—earned by American workers is up 22 percent.

• Median household income for all Americans (what, don’t the elderly count, too?) is up 6 percent in the past decade.

• The share of American households earning LESS than $35,000 a year continues to fall.

• The median net worth of American families, adjusted for inflation, is up by more than one-third since the mid-1990s.

• Total employment is up by 16.5 million and the unemployment rate is down. (And since when did liberals find it objectionable that Americans seem to have plenty of work to do?)

Critics of free markets and free trade may find it politically expedient to paint a grim picture of economic “stagnation,” but in the real world Americans continue to progress.

One of the hottest trends in health policy — wait, where are you going? — is for insurers to pay doctors and hospitals based on the value of their services. I know: how novel. But as it happens, in the United States we generally pay providers based on volume, rather than value. The new trend of value-based purchasing goes by the name “pay-for-performance” or P4P.

P4P can be tricky, since patients vary in terms of their preferences and how they respond to even high-quality care. So if you’re going to have insurers define and reward value, it makes sense to let patients choose their health plan. That way, patients can avoid a P4P system that might (ironically) leave them with lower-quality care.

Unfortunately, the government doesn’t see it that way. The federal Medicare program — which covers 45 million seniors and disabled Americans, making it the nation’s largest purchaser of medical services — is developing a P4P scheme that enrollees will find unavoidable, for two reasons. First, many Medicare enrollees do not have the option of switching insurers. Second, even if they do have that option, private insurers will simply follow the P4P scheme developed by Medicare. Why spend your own money doing something when a big government bureaucracy will do it for you?

The reactions to a study in this week’s Journal of the American Medical Association illustrates another concern with government-administered P4P. According to that study:

Safety-net hospitals tended to have smaller gains in quality performance measures over 3 years and were less likely to be high-performing over time than non–safety-net hospitals. An incentive system based on these measures has the potential to increase disparities among hospitals.

This is not necessarily a problem: a P4P scheme should penalize low-quality care and spur those hospitals to improve quality.

The problem is that when government administers the P4P scheme, the low-quality providers and their advocates will lobby their elected officials for more money in advance of improving quality. In some cases, such as safety-net hospitals, providers may indeed require more resources to improve the quality care. But because the P4P scheme is politically controlled, even providers who don’t will demand more resources — and get them. Moreover, what will those providers say if the “pre-improvement” subsidies fail to deliver any improvement? I’m willing to bet my hat that they’ll ask for even more subsidies.

As I argue here, better that we just let patients choose their health plan, and leave the P4P-ing to the private sector, where the low-quality providers won’t be able to lobby their way out of making some badly needed behavioral changes.

Yesterday I blogged about a Washington Post column by Shankar Vedantam that began: “About 35 million Americans regularly go hungry each year, according to federal statistics.” I looked up the federal data, and the real number appears to be about 9 million.

I queried the Post about the discrepancy, and Shankar kindly pointed me to this study produced by academic health scholars and the Sodexho Foundation. (I appreciate the prompt replies by both Shankar and the Post’s ombudsman).

The Sodexho study is a classic example of program advocates apparently inflating the size of a problem in order to prompt “Congress to expand existing programs,” as it proposes. I am not a health specialist, but it seems to me that Sodexho using 35 million for the number of Americans going hungry is a huge exaggeration. 

On page 10 and 11 of the Sodexho study, the authors admit that they are including both those people who occasionally go hungry and those who are “food insecure,” which is a far larger group. As I noted yesterday, the USDA puts the narrower group (those sometimes going hungry) at only about 9 million people.

While the Sodexho authors admit that they are using the broader group, they do not tell readers how vastly narrower the actual hunger group is. (The table on page 11 only shows the broader measure).

Also, the authors use “hunger” in the title, and they frequently claim that they are measuring the “economic cost of hunger.” On page 13 and 21, they say that 35 million people do not “get enough to eat.” But again, not getting enough to eat best describes 9 million people, not 35 million.

The Sodexho study takes the 35 million and calculates a cost of hunger in the United States of $90 billion. Obviously, the cost would be much less if the narrower and more accurate definition of hunger were used. 

To top it off, the authors of the study (page 21) have the chutzpah to claim that they are being “conservative” in their approach.

As I should have mentioned in my previous post, the House and Senate are likely to vote on the Farm Bill conference report tomorrow.

The bill, an abysmal one that carries a price tag of roughly $300 billion, will likely pass easily in the Senate, where an earlier version of the bill sailed through the chamber last year in a 79–14 vote.

So the questions over the possibility of an override center mainly on the House, which will likely see a closer vote, but not by much.

If House Republicans are unable to secure enough votes to sustain a veto, it would signify a remarkable failure of their leadership, especially of House Minority Leader John Boehner. Boehner has publically opposed the bill, but — along with House Minority Whip Roy Blunt — has refused to actively push his Republican colleagues to do the same.

An article in today’s The Hill notes:

[L]obbyists said members were being told to “vote their districts,” meaning they could support the measure without fearing any consequence from leadership.

What’s worse is that the bill probably could have been improved upon, much earlier in the process. The Republican leadership has full discretion over committee assignments. Instead of seating on the Agriculture Committee a balanced array of viewpoints, the House GOP leadership has chosen a collection of members that hail almost universally from farm-heavy districts and are greatly predisposed to support an increase in agricultural spending.

In fact, an informal vote count compiled by the office of Rep. Jeff Flake suggests that every single Republican member of the House Agriculture Committee is likely to support the Farm Bill tomorrow.

What would the bill look like if Rep. Flake or another critic of current farm policies was a member of the committee? Sure, one member can have only so much impact on a committee of 46. But at least that would give taxpayers a voice at the table.