Sunday, June 11, 2006
Cato Institute Member Does Scholarly Paper Debunking "Starve-The-Beast" Theory. Conservative Response: Mostly Silence.
The LAT's Jonathan Chait recently wrote about a paper by the arch-conservative Cato Institute's William Niskainen -- a paper that handily debunked the Grover Norquist myth that cutting taxes inevitably led to smaller government. Chait waited a few weeks to see if the sachems of the conservative movement had anything to say. Apparently, not much:
Out of the reams of conservative commentary published over the last month, I have found exactly two items reacting to Niskanen's research. Given his paper's devastating implications, the response is quantitatively — and qualitatively — pathetic. The first is an Op-Ed column by Nick Schulz in National Review Online. Schulz found Niskanen's finding a big puzzle. "Why would tax cuts prompt more spending?" he asks. "The only explanation so far comes from Niskanen himself," who hypothesizes that tax cuts make government cheaper, so voters want more of it. The only explanation? My column, which Schulz cites but apparently has not read, offered a different and (if I do say so myself) convincing explanation. I argued that Democrats are willing to inflict pain on constituents in the form of spending cuts in order to balance the budget but not in order to give tax cuts to the rich. So, when Republicans agree to raise taxes, large numbers of Democrats will join them to cut spending. This happened in 1982, '83 and '90. Democrats did it themselves in '93. But when Republicans cut taxes, Democrats refuse to give them cover to make politically unpopular spending cuts. Republicans feel obliged to prove to voters that tax cuts aren't hurting their cherished programs. The latest case in point: the Bush tax cuts resulted in a Bush spending boom. [...] The only other response I could find comes in the form of a single-paragraph mini-editorial from National Review. The editors have three points. First, they argue that tax cuts might "cause spending cuts after a few years." For example, they posit that Ronald Reagan's tax cuts may have "helped doom Bill Clinton's" healthcare plan. This might be persuasive if the Reagan deficits had stopped Clinton from trying to reform healthcare. But that's the opposite of the truth — Clinton pursued healthcare in part because of the deficits. Reform was an attempt to contain rising healthcare costs that were bankrupting government. And it failed not because of tax cuts and deficit pressure but because healthcare providers opposed it and helped convince the public that it would threaten their care. Second, they note the "economic case" for cutting marginal tax rates. But no economic model shows that long-term tax cuts without spending cuts help the economy. Even the most conservative economists favoring tax cuts predicate their support on spending cuts to go with them. Once you prove that tax cuts will raise rather than lower spending, that approach goes out the window. Finally, National Review's editors sniff that Niskanen's paper isn't that big a deal because it "would only prove that there is no easy way to get a welfare state to reduce spending." Huh? There is an easy way: Make a deal with moderate Democrats to raise taxes and cut spending! That's exactly what Niskanen found and what the last two decades have shown can succeed. But it's also an approach the conservative movement fervently rejects.Chait's second column on this subject is obviously intended to bait the GOP and the conservative movement into acknowledging that up is down and water is wet. But since the whole conservative movement is all about ignoring reality, I suggest that he not hold his breath waiting for an honest response.
Believe me, you don't want to bring up the Canadian health care system with someone who lives in a border state and has seen the buses of seniors and others going to Canada to get meds and medical care they can't get here. (The buses are still running, though the new demand for passports for persons crossing the Canadian border and the official displeasure of BushCo have reduced their numbers.)
Wanna know why Toyota, when looking to build a new plant in North America, chose socialized-medicine Ontario over all the various low-tax, low-education, low-infrastructure Southern states that were touting themselves as "business-friendly"? One reason was education: That darned socialized education that Canadians get is light-years better than what the folks in "right to work" states get. Another reason: Canada's socialized medicine is more efficient and costs less than the bloated US capitalist one, where the tyranny of the "wallet biopsy" means that a growing number of Americans don't get treatment for their illnesses. Canadians live longer, have a lower infant mortality rate, get better care in general and pay much less for it than we do.
I did a Google search as a reality check on the claim that "patients often have to wait weeks for critical examinations". I didn't find a definitive answer in one convenient location, but a survey of the results convinced me that this claim is a canard. There can be long wait times for elective surgery (i.e., if it's put off, you're not going to die, get worse, or suffer); but critical medical care is not delayed. I found many sites that referred to provincial and federal efforts to reduce wait times. Also, the wait times were attributed to a shortage of medical personnel, not to the method of payment.
I'm fed up with the claim that the Canadian system is worse that the U.S. system because people have to wait for [some] medical care in Canada. Waiting is better that not getting medical care at all.
Fistandantulus is simply moonshining and running, as is his modus operandi. He has not supplied a source, because he knows exactly how quickly this claim would be shredded.
Canada spends far less than the US on medical care, yet produces better outcomes, like living longer.
We are told by the right that private companies are so much more efficient than the government that they can deliver the same services cheaper, even while running a profit.
Under Reagan, "waste, fraud, and abuse" was the mantra. The Republicans would eliminate these and costs would painlessly drop. Well, from 1981-2006, they have controlled the presidency for 18 years, the Senate for 20 years, and the House for 14 years (16, really, but the Boll Weevils called themselves Democrats).
In that time, we learned that the reason that Republicans know so much about waste, fraud, and abuse is because they commit so much of it. Look at Bill Frist's family company.
A second line of defense was "regulation." Eliminating regulations would save huge amounts of money. Well, the Republicans have eliminated lots of regulations. Costs continue to spiral out of control, as any businessman can tell you.
And then there was malpractice. Malpractice ran about a percent of medical costs and was never a serious issue, but physicians-- especially the really bad ones-- ralied around that. Now the Republicans have all but shut people out of the courts, and costs continue to spiral up.
And, so what is left is hammering down salaries. Unfortunately for the Republicans, that means they are promising to hammer down the wages of doctors and nurses. Doctors used to be a Republican constituency. Now they are some of its most implacable enemies. And then there's the salaries of administrators. Every time someone has to call and ask if someone is covered, it costs money. And investors.
Unfortunately, the Republicans think that by muddying the issues, they can prevail politically. Instead, what they are doing is setting up a crisis that may very well bring down the medical system completely.
1. Health care costs for US health insurance aren't rising more quickly than private insurance. According to Kaiser: Typically, Medicare increases have been lower than those of private health insurance.
2. The failure to insure kills people: To take just one example, one study found that among Americans diagnosed with colorectal cancer, those without insurance were 70 percent more likely than those with insurance to die over the next three years.
3. Administrative costs in a for-profit system are much higher and have perverse effects: Insurance companies deal with [adverse selection in part] by carefully screening applicants to identify those with a high risk of needing expensive treatment, and either rejecting such applicants or charging them higher premiums. But such screening is itself expensive. Furthermore, it tends to screen out exactly those who most need insurance.
4. Employer-based insurance is socialism, but accepted by the right because the money goes through the hands of corporations rather than the health care consumer: Today, the value of the tax subsidy for employer-based insurance is estimated at around $150 billion a year. . Indeed, Medicaid has grown rapidly in recent years because it has been picking up the slack from the unraveling system of employer-based insurance. But because the poor don';t have any clout, Medicaid faces a possible unraveling in the face of rising health costs.
5. The problem of rising medical costs is not caused by moral hazard: The implication is that health costs are too high because people who don't pay their own medical bills consume too much routine dental care and are too ready to visit the doctor about a sore throat. And that argument is all wrong. Excessive consumption of routine care, or small-expense items, can't be a major source of health care inefficiency, because such items don't account for a major share of medical costs.
6. And the result is a disaster in progress: the United States does not stand out in the quantity of care, as measured by such indicators as the number of physicians, nurses, and hospital beds per capita. Nor does the US stand out in terms of the quality of care: a recent study published in Health Affairs that compared quality of care across advanced countries found no US advantage. On the contrary, "the United States often stands out for inefficient care and errors and is an outlier on access/cost barriers."
As Krugman says: things may have to get much worse before reality can break through the combination of powerful interest groups and free-market ideology.
In these battles between spin and reality, reality always wins. Which is why Fistandantulus doesn't stay around for his inevitable defeat.
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