And so it has absolutely no chance of seeing the light of day. Tyler Cowen links to this Reihan Salam post summarizing a good argument from Avik Roy’s new book:
offer a coverage option that better meets the needs of the poor while also reducing public expenditures:
Start by paying a primary-care physician $80 a month to see each patient, whether he is healthy or sick. That’s what so-called concierge doctors charge, and it would give Medicaid patients what they really need: first-class primary-care physicians to manage their chronic cardiovascular and metabolic conditions.
Dr. Lee Gross is a co-founder of an innovative company called Epiphany Health. He offers “concierge plans for the little guy.” Epiphany is designed primarily for individuals and families who don’t have traditional health coverage. Unlike Deamonte Driver’s mom, Alyce, who had to call dozens of doctors to find just one who would see her son, Epiphany’s doctors are on retainer. You pay $83 a month and receive primary care when- ever you need it. Spouses cost $69 extra, while kids cost $49.
“The most common medical conditions can be successfully managed at the primary care level, meaning most people do not need to see specialists,” Gross writes on his website. “There is also no reason to end up in the emergency room for minor illnesses or injuries because you have no other option.”
That’s the dirty secret of Medicaid. You might have heard the rumor that uninsured people are clogging emergency rooms because the law allows them to get free care there. But the unreported story is that it is Medicaid patients who clog the emergency rooms because they can’t persuade regular doctors to see them.
So give every Medicaid enrollee the Epiphany plan. Then throw on top of that a $2,500-a-year catastrophic plan to protect the poor against financial ruin. The total annual cost of such a program would be $3,460 per person, 42 percent less than what Obamacare’s Medicaid expansion costs. Heck, you could put the entire country on that kind of plan, along with giving people the opportunity to use health savings accounts to cover the rest. [Emphasis added]
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What I find particularly intriguing is Roy’s (perhaps playful) suggestion that “you could put the entire country on that kind of plan,” a step that would undoubtedly disrupt existing insurance arrangements, yet which would have the potential to increase disposable income, improve access to primary care, and encourage further business model innovation in the health sector.
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It seems reasonable to suggest that if we embraced a low-cost coverage model while also giving Medicaid beneficiaries resources they could use in any number of ways (to invest in their skills, to afford a home in a neighborhood with easier access to job opportunities, to share with relatives and friends, etc.) would improve subjective well-being just as much, if not more.
There’s much more to chew on there. Look, there’s lots in the realm of educational policy, health policy, climate policy and beyond that would really be a dramatic improvement over the status quo. And there is much that Team Reebok and Team Nike would agree upon if you asked them privately in a vacuum. But what folks like this fail to recognize (or maybe they do, but don’t want to douse their own articles) and what some of the “grand bargain” idealists (I used to be one of them) fail to recognize is that folks are not merely (or absolutely) interested in seeing better outcomes. They want to see better outcomes using their preferred worldview. They want their methods imposed, they want confirmation that they are more ethical, more intelligent, that their ideas are right and that they are in the correct tribe. This is true of almost everyone. Until we all stop wrapping up our own personal identity in our politics, and until we are honest with ourselves about our values and what virtues are required to meet those values, we’ll be stuck in an enormous food-fight and not have a clue as to why the catapults keep launching.
You assume that politics is split in some rough proportion like 70% consequences of outcomes and 30% identity politics. And that’s a very academic worldview: “most people are probably like me, mostly worried about policy outcomes but recognizing that those pesky feelings and tribalism keep getting in the way.” But that’s not the case. Politics are almost by definition cultural. We’ve found over the last few decades that voters and politicians alike either don’t know the material outcomes of their beliefs, expressly don’t care, or consistently pursue policies because of how it makes them feel ex post rather than what actually happens ex ante. What we’d really benefit from doing is actually dedicating some concerted study to how the mechanics of these political cultures and pageantries and religions emerge, rather than slamming our heads into a wall trying to rationalize something we don’t yet understand well. But that would take something like the study of, say, sociology, and we wouldn’t want to sully the cultural ethos of scientific positivism and social engineering, would we?
I think this is what I am trying to say, and that even “academics” like me are closer to playing identity politics than we want. It’s pretty evident from the way I write, if I were being unbiased, that I am trying to say something about me, even if not explicitly my intention. And indeed, I have openly lamented to end of good curriculum at colleges for a long time, and solid study in sociology (the James Coleman kind I would argue) among other disciplines would be required for all of us to at least appreciate the nuances of the world out there, much less claiming deep understanding.
So, +1 to your comment.
Yes, what a great idea, worth pursuing something like that. Perhaps if the entire country did not have to get with the program imposed from above. I am not talking about God here, worrying about making a cynical comment violating the First Commandment, and maybe others.
It begs the question, though, that this is a food fight. Yes, it is a fight about scarce resources, but it also about whether scarce resources can ever become more plentiful, and whether liberty is valuable too.
So yes, we are mired in a big mess, not just over prepaid chiropracty and birth control pills, but also over whatever they do, as in waste money, a proxy for scarce resources faster and faster.
So I think about what I would do if I were Lenin and had Rizzo, Blinder, and Krugman to advise me. Step One would be to keep Rizzo and send the other two East to manage the wheat harvest. Step two would be to buy wheat futures on margin. Step three would be to tell Rizzo to forget about the Five Year Plan and get busy brewing beer with scarce grain.
According to the latest communique from the Chinese Communist Party, the Chicoms are loosening up property rights in the hinterlands, but they were careful not to concede anything that might be interpreted as a violation of communist doctrine. As they say, the people are revolting. to them.