Specific Predictions For Health Care Reform

Megan McArdle has been writing a lot recently about the effects that Obamacare will have on American medical and financial well-being, and one of the things she's been demanding is testable predictions from progressives about the positive impact of the bill. Progressives have been hammering the idea that lower U.S. life expectancies, as well as higher rates of morbidity and infant mortality, are clear indicators that we needed a universal health care system. If in fact our lagging statistics in those indicators were due largely to a lack of universal coverage, they ought to improve dramatically over the next 30 years. With few exceptions (e.g. Nicholas Kristof's absurd contention that there will be significant increases in life expectancy as a result of the passage of this bill), very few progressives seem willing to go out on a limb and actually make predictions.

I'll make a few (hey, unlike journalists and healthcare bloggers, I don't have professional credibility to worry about). In the long run confounding factors that make it hard to evaluate actual cause-and-effect on many metrics will have come into play, so I'll state them partially in the form of negations of predictions that won't happen.

1.)The bill will probably save a number of lives, but the number will not be high enough to make an appreciable difference in life expectancy. Unless, that is, it somehow has the unintended benefit of causing young people to stop dying due to accidents, substance abuse and violence in numbers that, compared to those of other developed countries, are disproportionately high. Although I don't think there's a way to measure it, I suspect that the bill may also cost us some lives due to unintended and unfortunate economic consequences.

2.)There will be no statistically significant increase in infant mortality figures. That is, unless we start writing off rather than trying to bring to term high-risk pregnancies, and deal with the disproportionately high rates of malnutrition, substance abuse among pregnant women, etc. among our economic underclass (doing so is a goal libertarians and progressives ought to be able to cooperate on in my opinion).

3.)There will be no statistically significant decrease in morbidity, or particularly in rates of chronic conditions associated with poor diet and exercise habits (i.e. heart disease, obesity, etc.) unless Americans stop washing down quadruple cheeseburgers with 32 oz. sodas and eating pop tarts for breakfast, and/or stop watching TV for three hours a day and actually start exercising.

4.)The number of bankruptcies caused by medical expenses will go down somewhat, perhaps even precipitously. This is a good thing. As McArdle points out in the linked piece, however, this could have been achieved much more easily and cheaply.

5.)The bill will not contain costs for individuals. Medical services will continue to increase rapidly in cost due to greater demand from an aging population and expensive new products hitting the market (the prices of which will be further inflated due to new taxes on medical devices and medium-sized businesses which are passed on to consumers). For people who are already insured the mandates will increase the rate of premium increases, if they have any effect at all.

6.)The true cost of the program to the U.S. government over 10 years is going to be $2 trillion or more, not the $940 billion that's being touted. When you factor in the so-called "doc fix" to Medicare reimbursement rates that was rumored to be the price of A.M.A. support for Obamacare, it's already well up over a trillion, so I have 95% confidence in this prediction. Whatever the benefits of the bill are (and you'd have to be either intellectually dishonest or obtuse to deny that there will be some, perhaps even significant ones), they are not going to be worth the price we pay for them.

7.)Liberals will engage in goalpost shifting that would make Iraq war apologists proud rather than admit they were wrong if predictions #1-#6 are born out.

Oh, And About That Deficit...

Another problem with the Health Care Reform bill I forgot to mention in my earlier post - the fact that its likely cost overruns will put at further risk the U.S. government's already imperiled credit rating. If creditors become less willing to keep lending the Feds money without reservation, it will become that much more difficult to dig ourselves out of the financial hole we're in without drastically and painfully cutting entitlement benefits. The future is not looking pretty.

Fortunately the Onion has a solution.

Well, yeah...

President Obama has announced that without a health care bill, the U.S. will go "bankrupt" because of high medical costs. There's no doubt he's right about that - Medicare is a massive fiscal sinkhole that's only going to get deeper and wider as a greater share of the population ages into retirement. The problem is, he hasn't made a convincing argument that the bill that's on the table - or any bill that contains enough goodies to placate a sufficient majority of the various relevant special interests to stand a chance of passage - won't also cause us to go bankrupt. I am deeply pessimisstic about the possibility of some kind of sane reform - it's looking increasingly likely the problem won't be fixed until the service output end of the system stops working, and thanks to the miracle of irresponsible government borrowing that could be quite a bit farther off than the failure of the revenue intake end of the system is likely to be. We're not about to stop digging until this particular hole gets quite a bit deeper, I'm afraid.

Oh, Democracy...

Memo to everyone involved in the healthcare reform debate: it's rather hard to take anything from polls that show that "a majority of Americans favor a public option" when it appears that barely 50% have even a vague idea what a public option is.

Perhaps we ought to focus on educating the public about its government first?

And How

NPR has a story up about how fear is trumping logic and reason in the current debate about reforming the healthcare system, and it's completely on point. Following the debate is tremendously frustrating precisely because so many of the players involved seem intent on avoiding rational discussion of the issue in favor of fear-mongering to score political points, and the voters are too misinformed to know better. Anyone who has studied the health care problem seriously, or taken an in-depth look at the various approaches to providing health services deployed by governments in other industrialized countries, will realize that the American system is by most objective measures among the worst in the developed world. That is not an ideological statement - it's true irrespective of whether one favors bigger government or freer markets. Lefty complaints about the U.S. healthcare system are at this point well-documented, but (and this is an underplayed angle in the media's coverage of the debate) even from the perspective of a libertarian-leaning free market enthusiast like me, it's a complete mess. The American healthcare apparatus is not an open marketplace - it's a sclerotic tangle of overlapping and sometimes redundant government bureaucracy, inefficiently allocated private resources, and expensive, unnecessary red tape which costs twice as much as any other system out there and doesn't deliver anything more. It's not by any stretch of the imagination a free, open marketplace - thanks to differing state laws it's more like 50 different marketplaces, each with its own norms, rules, and price points, and because of the administrative costs that entails, no one but the largest and most well-entrenched companies are able to compete effectively on a nationwide basis. In wide swaths of the country the health care market has essentially been cornered by one or two players, and as anyone who paid a bit of attention in economics 101 can tell you, that's a recipe for higher prices and lower quality services. Furthermore tying healthcare to employment creates massive distortions in the labor market, restricting the ability of workers to change jobs, discouraging entrepeneurship, and hamstringing startup and small businesses. It's just as possible to envision a better system coming from the right as it is from the left - and indeed, some of the better systems out there are something closer to a true competitive marketplace. But who needs to acknowledge reality when you can trot out the bogeyman of government bureaucrats pulling the plug on grandma to score a few points in the polls in time for the next election?