{"id":312346,"date":"2010-02-12T14:25:13","date_gmt":"2010-02-12T19:25:13","guid":{"rendered":"tag:business.theatlantic.com,2010:\/\/3.35890"},"modified":"2010-02-12T15:10:24","modified_gmt":"2010-02-12T20:10:24","slug":"what-do-rightwingers-really-think","status":"publish","type":"post","link":"https:\/\/mereja.media\/index\/312346","title":{"rendered":"What Do “Rightwingers” Really Think?"},"content":{"rendered":"

Matthew Yglesias twitters<\/a> “Do rightwingers really believe that US health insurance has no mortality-curbing impact?”  Austin Frakt suggests that I am somehow in the grip of this ridiculous belief, and goes onto say<\/a> that the state of knowledge is beyond the point where we need to understand the size of the effect.<\/p>\n

I question the description of myself and Tyler Cowen as “rightwingers”–conservatives hate a good third of my positions at least.
<\/span><\/span>
But to answer the
\nquestion anyway, I thought I’d made it clear, but apparently not:  I
\nthink it is possible that the lack of insurance has no effect on
\naggregate mortality statistics.  I do not think that this is likely, but
\n I think it’s possible.  What I think is likely is that the effect is
\nnot that large, because if it were large, it would be very surprising to
\n see so little effect on the mortality of an elderly population with a
\nhigh mortality rate, or to have a study that samples 600,000 people and
\nfinds no effect.<\/p>\n

Mostly what I think is that the statistics are
\nreally, really flawed.  Not because the authors are bad social
\nscientists, but because this stuff is so hard to tease out.  Natural
\nexperiments are rare, and data sets often hard to come by.<\/p>\n

This
\nis about how I feel about the minimum wage.  My intuition is that demand
\n curves slope downward, so if you raise the price of labor, employers
\nare likely to consume less of it.  But if you can get a study like Card
\nand Krueger, than the effect simply can’t be that large–at least,
\nwithin the range that the US usually plays with the minimum wage.  I
\ndon’t think it’s particularly good public policy, because too much of it
\n goes to middle class teenagers and the like, and even small
\ndisemployment effects are dangerous for vulnerable populations.  But I
\ndon’t think it’s super-terrible public policy either.<\/p>\n

I’m much
\nmore convinced by the benefits of health insurance for certain
\nsubpopulations, particularly people with diseases we’re very good at
\ntreating.  HIV seems to pretty convincingly respond to offering public
\ntreatment–which also has a pretty compelling public health rationale.
\n(I don’t want to hear anything about spears
\n mounted on steering wheels<\/a>, thank you very much).  Medicaid
\nexpansions provide some pretty good natural experiments, IMHO,
\nindicating that you can improve infant mortality.  Poor people with
\nhypertension get better blood pressure control pretty consistently.<\/p>\n

But
\n this doesn’t imply a large effect in the macro data if we extended
\nhealth coverage, precisely because not that many people under the age of
\n 65 die of things we can treat.  That whole age group is only about a
\nquarter of deaths, and some of them are from things like metastatic
\ncancer or auto deaths, in which more health care coverage can at best
\neke out moderate further improvements.  (That may not be true in the
\nfuture.  It is now, sadly.)<\/p>\n

Obviously, this matters.  If 45,000
\npeople die a year, this makes a more urgent case for overlooking the
\ndrawbacks of single payer than if 1,000 people die a year–there are
\nprobably more cost-effective ways to control those deaths.<\/p>\n

But
\nthat is far from the whole calculation.  The mortality question is
\nreally important, but it doesn’t touch non-mortality outcomes, which are
\n even harder to measure comprehensively.  It doesn’t touch on the
\nfinancial questions raised by medical bankruptcies–I think they’re
\noverstated by the Himmelstein\/Woolhandler crowd, but that doesn’t mean I
\n think they don’t exist.  It doesn’t address the social justice
\nquestions.  It just says, this is probably not the best grounds upon
\nwhich to make the case for national health care, because we don’t have a
\n good handle on the number.<\/p>\n

What it might do is point us towards
\nthe shape of expansions.  To the extent that the data make a strong
\ncase, it might point to more modest interventions:  prenatal and infant
\ncare.  Tuberculosis and HIV.  Certain kinds of chronic conditions
\n(hypertension is really relatively cheap to treat, and very important,
\nalthough as with diabetes compliance is apparently a giant problem even
\nwhen there aren’t cost barriers).   I’d probably support most of these.<\/p>\n

But
\n the core question for me is not whether there’s any effect–I’m willing
\n to consider the possibility there isn’t, but I tend to assume there
\nis.  The question is, how big? Because if it exists, but it’s too small
\nto measure, it might not be the issue our government should be most
\nfocused on.  Particularly when you consider that there are costs, as
\nwell as benefits, to a national health care system.
<\/span><\/span> <\/p>\n



\n

\n Email this Article<\/a>
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\n Add to Reddit<\/a>
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\n Add to del.icio.us<\/a>
\n Add to StumbleUpon<\/a>
\n Add to Facebook<\/a>
\n

\n\"\"<\/a>
\n\"\"<\/p>\n","protected":false},"excerpt":{"rendered":"

Matthew Yglesias twitters “Do rightwingers really believe that US health insurance has no mortality-curbing impact?”  Austin Frakt suggests that I am somehow in the grip of this ridiculous belief, and goes onto say that the state of knowledge is beyond the point where we need to understand the size of the effect. I question the […]<\/p>\n","protected":false},"author":80,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"class_list":["post-312346","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/312346","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/users\/80"}],"replies":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/comments?post=312346"}],"version-history":[{"count":0,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/312346\/revisions"}],"wp:attachment":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/media?parent=312346"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/categories?post=312346"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/tags?post=312346"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}