Friday Roundup, March 7th

  • Don’t miss this essential new report from James Copland and Isaac Gorodetski on the exciting government entrepreneurs who practice Regulation by Prosecution?

Richard Reinsch is a fellow at Liberty Fund and the editor of the Library of Law and Liberty.

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Comments

  1. nobody.really says

    Did you know that when it comes to healthcare, individual choice is overrated? I’ll let Ezekiel Emanuel tell you why. I wonder, though, why those with means are placing themselves and their families in concierge medical care?

    If you have a link where Emanuel tells us why, please provide it. You merely provide a link to a column with the title “Choice is overrated.” Emanuel almost certainly did not write the title.

    If you’d bothered to read the parts that Emanuel actually did write, you’d see that he’s saying that choice is very important. It’s important for insurers in picking which physicians they cover, to ensure the best combination of cost and quality – that is, to harness some of the benefits of market forces. And thus it’s important to patients when picking which insurance plan to join.

    The “choice” that Emanuel challenges is the idea that consumers should be entitled to see out-of-network physician at in-network costs – the “Can I still see my own doctor?” question. Doubtless there are people who find fault with Emanuel’s analysis, but I’m a little surprised to find them here. Is Liberty Law Blog taking a bold new position to defend people’s sense of entitlement to consume without paying?

    • Richard ReinschRichard Reinsch says

      Nobody.really,

      Despite your insult and unfortunate tone, I’ll respond to your comment. I did read the piece. I should say that at least Emanuel is honest about the deeply intrusive paternalism of Obamacare. Witness his performance with James Capretta a few months back. He has no problem saying in this column that certain people have networks that are inferior. By whose standards?

      Since they are inferior, we can force them into new plans, we are justified progressives and not controlling, regulating bureaucrats. Moreover, such thinking completely ignores tradeoffs, scarce resources, and costs. Perhaps these are the plans they want or that they can afford. Perhaps we should bump them up with a subsidy to enroll in a better plan; however, it doesn’t follow that you have their plans cancelled and shoved into a new plan via government coercion. This by its very nature is a restriction on choice, the point of my post.

      Moreover, what many are reporting is that their networks under Obamacare are reduced and more expensive. But this shouldn’t be surprising to anyone who follows the path of government regulation and its need to consolidate industries that it heavily regulates underneath large firms. By all means, yes, if you contracted with a network, then that’s your commercial agreement. Emanuel is using this as a parry to get to his real point, we are giving you “actual” choice with Obamacare plans. Emanuel may very well be the last person authentically defending Obamacare in America. Except for, well, nobody.really.

      • nobody.really says

        Nobody.really defends Obamacare. Well, I guess that’s a fair statement, although not necessarily how I would have phrased it.

        As for tone, please explain the relationship between Emanuel’s column and your question “I wonder, though, why those with means are placing themselves and their families in concierge medical care?” You seem to imply that there’s some contradiction between this fact and Emanuel’s column. I’m not seeing it. I’m only seeing a cheap shot exploiting a mischaracterization of the column’s title.

        Feel free to challenge Emanuel and Obamacare. But the fact that you find fault with many things Emanuel says is not a justification for finding fault with him when you are (presumably) in agreement. Some people have gotten the idea that because Obamacare was designed to make heath care more affordable to many people that there will be no costs and no trade-offs. Emanuel is disabusing people of that notion (while, true, then offering some ideas that would help reinforce that notion). Even if you oppose Obamacare, you should favor disabusing people of false ideas about Obamacare.

        Anyway — let’s judge ideas on their merits, not on the merits of the person who states them.

      • says

        Richard,

        Dr. Emanuel hints at much more of his agenda than you give him credit for. Some of it makes sense, from a dystopian industrialized point of view, even it makes it more obnoxious to libertarian instincts.

        Emanuel uses a kind of code that is obscure in general discourse, but is familiar to people engaged in healthcare policy. The underlying (undoubtably true) premise of Emanuel’s argument is that it is cheaper to care for people who are relatively well than for people who are very sick. His reference to Kaiser is telling in this regard, since even Kaiser doctors will tell you, they are structured to provide efficient care to a relatively healthy population rather than cutting edge care to very sick ones. Kaiser refers a number of patients to centers such as the University of Colorado Health Sciences Center. Except when they don’t, a circumstance indistinguishable from Emanuel’s trope about “…this shouldn’t come down to luck; it should be the basic standard of care.” This is not a criticism of Kaiser; for the most part Kaiser enrollees get what they pay for, and accept that trade-offs will exist for higher complexity care. It is at this point where I believe your criticism of Dr. Emanuel is most valid: why should the government tell us what trade offs we have to make?
        —Let me post this in sections so I don’t get stuck with that “Your comment is awaiting moderation” annoyance.

      • says

        Dr. Emanuel’s strategy makes perfect sense at first blush. Since the vast majority of people are relatively healthy, force them into plans with limited provider networks. Ration by queue; since these people are reasonably healthy, they will therefore consume less resources with relatively little impact on their overall health. If relatively well people were allowed to let their anxieties access the more specialized, less efficient but presumably “better” higher end care, cost would rise, less people would have access to care and care would be rationed not by queue but by ability to pay. Healthcare would be more expensive, less efficient and with no appreciably better results. This is why the healthcare systems of rat holes like Cuba appear on paper to be “better.” The U.S. spends disproportionately more on higher end care, which, for the same reason a Ferrari costs more than a Scion, costs significantly more for the marginal improvement in performance. From the standpoint of theoretical efficiency Dr. Emanuel at least sounds plausible.

        Dr. Emanuel appears to lose his nerve though and seems to let on that he doesn’t believe his own arguments. His four ways of assuring Americans that they are getting high quality care discloses his lack of confidence. What Emanuel is really saying is that relatively well Americans do not need “high quality” care; “good enough” is just that, and good enough is cheaper that what Americans appear to want. He won’t say it though, and this is where I believe you have the better part of the argument. This particular health care debate extends way beyond healthcare considerations. It affects the economy, the relationship between the citizen and the state, individual autonomy and the right of individual people to decide for themselves what is most important for them when confronted with a healthcare issue.
        — Second break

      • says

        This ultimately comes down to individual values, which cannot be regulated by central bureaucracies. The fact that any coercion is involved suggests, pretty convincingly, that what is contemplated is contrary to certain people’s values in a fair number of cases. This is not inconsequential, either for its implications on a free society or for the practicality of the ACA itself; the low enrollment numbers and poor public opinion of this boondoggle bear this out.

        The language Dr. Emanuel uses in his four recommendations point out the weakness of the ACA as a creature of sound policy: “should require,” “should have to publish.” Use force to make the damn thing work. Well all you have is a hammer…

        Then he all but gives the game away with his fourth recommendation: Insurance companies “should incorporate a ‘safety valve’,” i.e. provide an escape from the unintended and potentially catastrophic effects of a half baked, overly ambitious, ideology-addled and poorly executed mess of a policy.

        —Note: I double post this because I accidentally posted it as a reply to the original post, rather than as part of my reply to Richard’s response to nobody.really. I posted it again to maintain the form of the response, and because the little ribbon thing that shows up when you respond to Richard makes my nickname look more dignified.

  2. says

    This ultimately comes down to individual values, which cannot be regulated by central bureaucracies. The fact that any coercion is involved suggests, pretty convincingly, that what is contemplated is contrary to certain people’s values in a fair number of cases. This is not inconsequential, either for its implications on a free society or for the practicality of the ACA itself; the low enrollment numbers and poor public opinion of this boondoggle bear this out.

    The language Dr. Emanuel uses in his four recommendations point out the weakness of the ACA as a creature of sound policy: “should require,” “should have to publish.” Use force to make the damn thing work. Well all you have is a hammer…

    Then he all but gives the game away with his fourth recommendation: Insurance companies “should incorporate a ‘safety valve’,” i.e. provide an escape from the unintended and potentially catastrophic effects of a half baked, overly ambitious, ideology-addled and poorly executed mess of a policy.

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