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If I were Ezra Klein
Just to define our terms, I take Ezra Klein to be a guy who believes that a single-payer system is clearly a good idea and that in the meantime government-provided universal health care coverage is far better than the status quo, albeit highly imperfect compared to single-payer systems.
If I were Ezra Klein, I would love Barack Obama and his willingness to drop the forced mandate idea. But Ezra doesn't seem to love Barack Obama for that.
I would think that Americans are a fairly libertarian people in some (selective) regards, and that we need to frame progress as "new and concession-laden, choice-friendly version of national health care." I would know full well that lack of a mandate has efficiency problems, because otherwise people don't sign up until they get sick and adverse selection makes it unprofitable to sell insurance.
But then, if I were Ezra Klein, I would think: "Ah, at that point there is no turning back. Private health insurance companies will have to look to government for further financial aid. This might even evolve into single payer someday, and that is probably the only way we would ever get there, given American Exceptionalism." I also would think: "I [President Obama] can change my mind on the mandate later, if need be. Only policy wonks follow the flip flops on such details. And perhaps the mandate could be implemented indirectly -- maybe at the state level, or framed in some other way -- so that my hands are clean of apparent contradiction." I also would think: "The mandate can't force everyone to buy health insurance anyway -- forced auto insurance mandates don't always work -- so the mandate by no means eliminates the adverse selection problem anyway."
Most of all, I would think that Democrats should not waste their energy fighting -- prematurely I might add -- intra-party battles over issues of mostly symbolic importance.
If I were Ezra Klein, I would think that only Barack Obama has the calm, reassuring manner required to lead America down a difficult and controversial path. Only Barack Obama (and not Hillary Clinton) would enjoy a true honeymoon period as President, and maybe that is what is required to push through major health care reform. Only Barack Obama would be seen as approaching this issue from a fresh start and without biases.
If I were Ezra Klein, I would worship at the shrine of Barack Obama. I would send Barack Obama random postcards of love, affection, and yes money.
But I am not Ezra Klein, and I am not sending postcards to anybody. Instead, I am sending you this blog post on "If I were Ezra Klein."
Addendum: If Ezra Klein were Ezra Klein.
Posted by Tyler Cowen on January 12, 2008 at 10:12 PM in Medicine | Permalink
Comments
This is sad. Look. Ezra debates policy on the merits. This is policy by the gut.
Private health insurance is the root problem of our system. They're old technology Tyler, obsolete. Horse and buggy. They provide no essential function worthwhile for carrying into the future, unless keeping fat people and the poor both unhealthy and short lived is essential to your worldview.
Not to mention this is patronizing to the extreme.
And you leave yourself open to the ridiculous: You are no Ezra Klein.
As I said, sad.
Posted by: Russell L. Carter at Jan 12, 2008 10:52:22 PM
Hold on there, Russell, if Tyler and Ezra were the only two pundits on Earth, we'd all be better off. Throw in Greg Mankiw and Matt Yglesias, and you'd probably account for 80% of all the punditry on the net that's worth reading.
Posted by: Pup, MD at Jan 12, 2008 11:13:24 PM
I don't see what, you, Russell are so upset about. I'm entertaining the view that Ezra is right on health care, and asking what my attitude toward Obama's view on mandates should be. I am quasi-defending Obama by saying he is truer to the Democratic worldview than many of his critics indicate, and that perhaps he provides a surer path to Ezra's ends. There is nothing in this post that is trying to defend private health insurance (though that is my view, which I have defended on other grounds elsewhere). I think you are reacting by rehashing the same old same old partisan debates you are used to.
Posted by: Tyler Cowen at Jan 12, 2008 11:17:15 PM
Russ,
LOL. Ezra is a journalist, Tyler is an economist. I read both both blogs daily. Don't even pretend to think for a second that Tyler doesn't understand and conceptualize this entire issue better than Ezra. That doesn't mean Tyler knows everything or is an expert....nobody is.
But if you take their writings on economic issues as a whole, Ezra can't hold a candle to Tyler. Most of what Ezra writes about health care is emotional laymen's punditry and folksy economics.
If Tyler takes a moment to write a post that isn't steeped in economic wonkiness, I can let it slide based on the majority of his writing.
Posted by: Anom. at Jan 12, 2008 11:24:55 PM
Russell,
you want to talk about debating the merits? Check out Ezra's latest on this matter and be sure to read the link back to this site that Ezra bases it on.
This is but one example. You talk about "the merits". BTW, no liberal economist would ever defend single-payer or universal health care on the grounds you provided. Even they have some appreciation or Hayek, Kirzner and the best of Schumpeter...even if they don't really like them.
Posted by: John V at Jan 12, 2008 11:32:00 PM
Oh, I just have to add:
Ezra debates policy on the merits. This is policy by the gut.
The Irony! Up is down and down is up.
Posted by: John V at Jan 12, 2008 11:35:29 PM
Tyler:
First: What is the "Democratic worldview"?
Second: you write:
"There is nothing in this post that is trying to defend private health insurance"
Exactly why would you explicitly "love Barack Obama and his willingness to drop the forced mandate idea" unless otherwise?
That's a rather interesting implementation detail that I'd love for you to elaborate on... how does that work exactly? Krugman has pointed out the rather simplistic problem with this, you wouldn't be trying to set things up for failure would you? As an economist, you would certainly understand the competing forces.
"I think you are reacting by rehashing the same old same old partisan debates you are used to."
Right. Ok then. That's projection, I'm projecting, everybody ok.
Or how about I turn the tables:
As a tenured member of the class of academic economists who feel (rightly or wrongly) a need to defend the status-quo, you are understandably providing various ad-hoc arguments that miraculously evolve over time to support your cause.
Best,
Russell
Posted by: Russell L. Carter at Jan 12, 2008 11:37:11 PM
I think there is a genuine, authentic sentiment from both moderates and conservatives (including libertarians) that goes something like this:
Obama is to the left of Hilary. He would likely be more difficult to beat in a national election and would likely be able to implement change more effectively.
But he, unlike Clinton, is more prudent and intellectually honest.
I'll be honest. Why one earth would Democrats vote for Clinton instead of Obama? It's almost like the Democratic party would rather inflict pain on both themselves and Republicans as some sort of revenge against Bush. I don't get it.
Posted by: thehova at Jan 13, 2008 12:16:09 AM
Can we generally agree that all so-called "single-payor" concepts are really "multiple-payor" since they are based on taxpayers through governments or members of groups formed by coercion of governmental legislation (a la Massachusetts)?
Posted by: R. Richard Schweitzer at Jan 13, 2008 12:21:39 AM
If I were Ezra Klein, I would respond to this post with a blog post of my own, on my blog at The American Prospect, which I would also title "If I were Ezra Klein." My post would close with a somewhat subtle, cleverly indirect reference to the authority that I would have on this issue in virtue of actually being Ezra Klein.
As someone who is not Ezra Klein (nor Tyler Cowen), I'll just write a comment here. Tyler, it sounds like your main disagreement with Ezra here is on two points:
1. You think that it will be easier for the Dems to pass a healthcare plan without a mandate; Ezra thinks that their healthcare plan will probably need to include a mandate.
2. Ezra thinks that Obama criticizing mandates will make it harder to pass a plan with a mandate in the future; you do not.
Ezra also hasn't bought in so thoroughly to the superiority of Obama's theory of change.
Ezra agrees, I think, that any of the Dems' healthcare plans will probably lead to further steps towards single payer after it's passed.
Your other point - that Dems should not be infighting over the details of their healthcare plans - appears to be the main point that Ezra was making in the post that you are responding to ("The absence of a mandate in [Obama's] plan was a minor disappointment. But his decision to launch an assault on the very idea of the individual mandate was a major problem."). But he thinks that they should avoid attacking each other's plans because that could undermine their ability to get them passed in the future - point 2 of your disagreement. What's the problem with fighting intra-party battles on your view? And what do you mean by "intra-party battles?"
On point 2 of your disagreement, I lean towards Ezra, though I think he's overstating the case when he says that "it's overwhelmingly likely that the airwaves will be blanketed with Barack Obama's arguments against" mandates if the Dems end up with a proposal that includes a mandate. It will be harder to pass a healthcare plan if Democrats are on record criticizing major components of the plan.
On point 1, I don't really know. Mandates do open an avenue for attacking a health reform plan, as we can see by the fact that Obama is trying to get political mileage out of those attacks in a Democratic primary. But if not having mandates makes the plan less effective, or more complicated, then that could also make it harder to pass. And I don't know much about the mandate-substitutes that you (and some of the commenters at Ezra's) have brought up. How well would they work? Are they open to the same line of attack as mandates?
Posted by: Blar at Jan 13, 2008 12:41:15 AM
"Why on earth would Democrats vote for Clinton instead of Obama?"
Because so many of them are so irrationally angry at bush and the GOP that they are more concerned with having their anger and partisanship voiced than having their goals accomplished.
Posted by: ben g at Jan 13, 2008 1:29:44 AM
The reason we live better lives than people a hundred years ago is mostly because of technological innovation, especially advances in medical technology.
Where's the debate regarding the implactions of single payer, mandates, or the present system for medical innovation?
Umm... also there's the fact that Medicare, Medicaid and the VA do not inspire confidence in the Federal Government's management of health care.
Posted by: PJ at Jan 13, 2008 1:32:47 AM
Oops.
"implications."
Posted by: PJ at Jan 13, 2008 1:35:28 AM
If you were Ezra Klein, or any other major named left-wing blogger, you would feel strongly that attitude in politicians trumps policy. Among the Ezra Klein's of the world, the problem is much less what Obama says, but how he says it. Dealing with issues like adverse selection? Who can be interested in things like that when there is a future to be seized.
Posted by: James Feldman at Jan 13, 2008 2:11:26 AM
If I were Ezra Klein, I would worship at the shrine of Barack Obama.
Posted by: Polybius at Jan 13, 2008 2:53:21 AM
The whole "If I were..." theme reeks of falseness, no matter who does it.
Let's provide an example. Tyler says "Americans are a fairly libertarian people".
"If I were one of a fairly libertarian people, I wouldn't bother to vote because rational choice theory says that the expected difference to the outcome from my one vote doesn't justify my effort."
Note how much is left out of the argument? Other motivations (and even the fact that most people vote) are left out. But it gets worse: even if all the factors are accounted for, the weighting might not be right.
No, the "If I were..." theme is a lame disguise to reframe ignorance while speaking propaganda. It would be much better written as "I don't understand why..." Only a fool would accept framing that makes an opponent look as if he is giving friendly advice.
Posted by: Mike Huben at Jan 13, 2008 8:04:43 AM
Mike Huben, when you quoted me you left out the phrase "in some (selective) regards" from my sentence, which makes all the difference in the world for your point.
Posted by: Tyler Cowen at Jan 13, 2008 9:03:50 AM
It bothers me that journalists are given the same presumption of validity as economists in public debates about the economics of policy.
It pains me that economists like Tyler indulge that perception of equity.
Posted by: M. Hodak at Jan 13, 2008 9:53:36 AM
Oh, goody, if the linked article is representative, this is another journalist proposing ad-hoc subsidies for his ideological whims. "Don't subsidize soy." "Do subsidize fruits and vegetables". Farm subsidies aren't bad because the distort the market, they just don't choose the "right" green things that would make us all healthier? Why does this guy deserve any serious respect? More Crooked Timber and Rosser and less Krugman and Klein.
Posted by: Billare at Jan 13, 2008 11:00:49 AM
Tyler,
What person with a shred of economic literacy would say things like, "we think the end of insurers will be a good thing" and "the profit motive is largely pernicious in the delivery of heath care" and the general notion that it's government that must "adapt against" the market. I'm flabbergasted that you give this guy any airtime.
Posted by: M. Hodak at Jan 13, 2008 11:25:53 AM
Thehova has got my thinking down. I'm not sure why thehova thinks that only moderates or conservatives would use this logic - lots of liberal Obama supporters think this way as well. We have someone who looks like a strong candidate with progressive positions and very considerable appeal to independent / centrist voters (note that this isn't a very typical combination). Plus he is intellegent and appears intellectually serious (particularly in comparison to most politicians). Obviously supporting any candidate involves some risk because nobody really knows how things will play out. But from what we know now, what is not to like from the Dems point of view. Especially compared to someone (Clinton) who already has 45% unfavorables and will unite the opposition all while being, if anything, to Obama's right.
A lot of Clinton support is probably explained by residual Clinton loyalty on the part of many Dems, not any sort of thoughtful calculation of the pros and cons. Another part is based on the (to my mind questionable) belief that Clinton is the least likely to make mistakes in the campaign or in government and most likely to be a tough fighter on both fronts.
Posted by: ikl at Jan 13, 2008 1:39:28 PM
Hmmm... in my experience, Americans talk a libertarian game, and then immediately scurry off to find someone to tell them what to do. Under a veneer of independent thought, they seem largely ignorant of their own history, unwilling to debate current issues seriously, and generally happy to drift along, occasionally squeaking when they realize that they have been played for fools - again! This is exactly why Hillary Clinton, despite being self-evidently a disastrously bad choice for the Presidential candidacy, still attracts the votes of people longing for "authenticity/experience/anything else the Clintons decide to lie about on prime time tv". Of course, the fact that she is about as authentic as a McNugget is neither here nor there. Yes, the Dems may choose her - but they can't make most people vote for someone they have distrusted and disliked for years. That's a realistic approach - but not one you can sell to the "libertarian" masses.
Posted by: nickzi at Jan 13, 2008 2:07:48 PM
As an aside, here are some thoughts on Obama vs. Clinton from a moderate (me), since a few commenters can't believe anyone would vote for Clinton. I actually like the fact that Clinton is less liberal than Obama, particularly because I worry about what Obama might do in areas like trade. I also think Clinton's experience really does show through, most notably in her ability in the Senate to work with Republicans who couldn't stand her but having grudgingly given her some respect. Finally, some of Obama's talk sounds like a lot of hot air to me, and I'm skeptical of anyone's ability to get bipartisan support through "can't we all get along" politics. I see the "honeymoon period" as a myth regardless. At some point it boils down to horse trading, and I'm more confident in Hillary's abilities in that area.
Having said that, I like Obama ok as a counterweight to eight years of Bush. And I am concerned about Clinton's negatives. And handicapping political ability is very difficult. Obama may have the right combination of intelligence, ambition, and charisma to be an extremely effective president. I'm just not sold on it given his limited experience, airy talk, and soft approach.
Ok, now back to the main topic. Isn't a multiple payer government sponsored plan a hopeless muddle regardless of the mandate? Lack of a mandate presumably results in rampant adverse selection, but even having a mandate doesn't eliminate that issue. And all of the state attempts to implement similar plans (MA with Romney, VT with Dean, and a host of others) have failed to budge uninsured rates largely because of high prices. I tend to think that any plan built on the complexity of the current healthcare provider and insurance system results in continued high costs and prices.
I agree that the "If I were" hook is a less than ideal one, but I also think some of the commenters should be less eager to assume bad intentions. Try to take people's writings as honestly intentioned, and they'll be more likely to do the same for you.
Posted by: Greg at Jan 13, 2008 7:25:35 PM
Addendum: If Ezra Klein were Ezra Klein.
If I were Tyler Cowen, I would know the proper and improper uses of the subjunctive mood.
Posted by: Rich B. at Jan 13, 2008 7:28:47 PM
Regarding the comment above: Medicaid and Medicare are payors not providers. The VA is both. There has been some press lately that the VA might be the best health care system in the world.
I fail to see exactly what innovation insurers provide, aside from fine print and 20% premium increases per year.
And having good insurance is no guarantee that you will actually get coverage. My wife's oncology surgeon dropped our insurer just prior to surgery. The lab also dropped the insurer, the largest in the state.
Ask your GP how much staff and time devotes to jacking with private insurers. My GP says about 50% of his staff's time is spent haggling over coverage. Even he also has to spend time on the phone with insurers.
I really fail to see what insurers add to the actual delivery of care.
And 'If I Were Ezra Klein' conceit makes you seem like a jerk. It needs some work.
Posted by: Nat at Jan 13, 2008 7:33:15 PM
