Monthly Archive for March, 2017

Politico Economy

Matthew Nussbaum of Politico tweets that:

There are 50,000 coal miners in the United States. There are 520,000 fast food cooks. Coal miners seem to loom a lot larger in our politics. Wonder why.

If Mr. Nussbaum had read pages 36 and 37 of The Armchair Economist, he’d know the answer. Coal mines are in pretty much fixed supply; new fast food joints are created all the time. Therefore new coal mining jobs are far harder to create than new fast food jobs.

So if conditions get better for coal miners, that’s good for existing coal miners. By contrast, if conditions get better for fast food cooks, more people will become fast food cooks, driving down the wages of existing fast food cooks and negating the improved conditions.

That makes it worthwhile for coal miners to lobby for better conditions, but not for fast food cooks. What’s relevant is not so much the current population of coal miners, but the ease with which that population can expand.

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Information, Please

Why do we need a national health policy, any more than we need a national grocery policy or a national automobile policy or a national matchmaking policy?

Over on another recent thread, one of our commenters keeps pointing to allegedly unique “information issues” in the market for health care. So let’s see how unique those issues really are.

First, there are issues like adverse selection. The very fact that you’re buying insurance makes sellers suspect you’re sick, and they charge accordingly. Therefore if you’re not sick you overpay, and because you overpay you’re likely to underinsure.

That issue is not unique to health insurance. It also plagues the markets for car insurance and homeowner’s insurance, along with plenty of other markets. The very fact that you’re selling a used air conditioner makes buyers suspect there’s something wrong with it, and they lowball their offers accordingly. Therefore, you can’t get a good price even for a perfectly good air conditioner, and because you can’t get a good price you’re less likely to list it for sale in the first place. That’s exactly the same adverse selection problem (with buyers and sellers reversed), but there’s no general clamor for a national used-air-conditioner policy.

That’s not to say that adverse selection is unimportant, or that we shouldn’t try to address it, and it’s not deny that it might loom larger in some markets than others. But it’s far from unique to the market for health insurance.

Another information issue — one being flogged endlessly by a persistent commenter in that other thread — is that providers generally know a lot more than their customers do about the merits of various medical procedures. This is presented as if it were a reason for providers (e.g. doctors, insurance companies, or federal program administrators) to make key decisions, as opposed to presenting the customer with a price list from which to choose — the same method that seems to work perfectly well in restaurants, auto repair shops and lawyers’ offices.

But all of this overlooks the biggest information issue of all which is this: Only the customer knows whether he’d prefer, say, three weeks of pain relief to, say, a new car stereo, or whether he’d prefer, say, a slight lifelong reduction in heart attack risk to, say, an extra five restaurant meals every year.

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The Dire Prognosis

Here is what I wrote on this blog the day after the election:

The big loss is that there will be no unified right-of-center voice in American politics. Toomey, Portman and the rest of them will do what they can, but it’s Trump who will be taken to define Republicanism, which is to say that Republicanism will henceforth be pretty much the same thing as Democratism.

It gives me no pleasure to observe that with the new Trump-endorsed Republican health care plan, I stand vindicated.

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Missed Opportunities

I haven’t seen any of the details, but it looks like the Republican health care plan suffers from many of the same defects as Obamacare, and is in some ways worse.

Mainly: As far as I am currently aware, the plan pretty much leaves in place the main ongoing problem with health care, which is that most people are grossly overinsured, so that health care choices are too frequently made by insurance companies instead of by (cost-aware) consumers and providers. The solution, in broad terms, is to replace insurance with individual health savings accounts (which, if you’re worried about this sort of thing, can be just as heavily subsidized as insurance is). Plenty of Republicans know this, and have been saying it for a long time. But — at least according to what’s in the early news reports — they seem to have come up with a bill that ignores it.

In fact, the Republican bill makes things worse in at least one way, by lifting the Cadillac tax on employer-provided health care plans, thereby encouraging even more overinsurance.

Presumably this was the compromise among feuding factions that the Republican caucus was able to hammer out. Presumably, too, a little leadership from the one person with veto power could have yielded a much better outcome. Too bad the one person with veto power is a self-obsessed loonybird. I do believe a President Bush or a President Cruz — or even, perhaps, a President Clinton — would have insisted on something far far better.

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