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What is a Progressive?

A professor at one of our leading universities teaches a course in health policy and decided to assign my book, Priceless, to his class. He also contacted some prominent “left-of-center” health economists to see if he could balance my book with something from the other side. Here was his query:

People like Peter Orszag and Uwe Reinhardt have said that even though they don’t agree with everything in Goodman’s book, it is sound economics and definitely a book that should be read. Is there a left-of-center book that is like Goodman’s — one that is economically defensible, but one that scholars like Goodman, Mark Pauly and Steve Perente would admit are worth reading?

The answer was “no.” There is no such book.

I find this rather amazing. It is no secret that 99.9% of the health policy community is liberal — or if you like, “progressive.” So why is there no book describing a liberal approach to health policy?

As I began to reflect on that fact, it occurred to me that this phenomenon goes way beyond health care. Milton Friedman’s Capitalism and Freedom is a classic example of using economic analysis to make the case for a free economy. In it, Friedman argues for school vouchers, a flat tax, an end to occupational licensing, private savings rather than Social Security, a monetary rule, etc. Is there any comparable book on the left, using economics to defend liberal institutions against these reforms? I believe the answer is “no.”

Just what the truth is
I can’t say any more.

Feb 27, 2013 | 25 comments | by

The Crown Jewel of ObamaCare Failures

Now we get to the biggest failure of them all — the individual mandate. The premise was simple: If people aren’t buying what they should (in this case, health insurance), pass a law telling them they have to, and they will. Presto, Change-o problem solved!

Now, to be fair, Congressional Democrats weren’t quite that simple minded. They threw in lots of subsidies and required that insurers enroll anyone who applied, no questions asked. So, they made it affordable and available, along with being mandated. So, it should work like a charm, right?

Well, maybe in a vacuum. But in reality this rule is being inserted into a very complex and mature system of existing subsidies, responsibilities, and incentives. In this case, one of the primary factors is the role of employers in providing and paying for coverage.

Dec 05, 2012 | 25 comments | by

Myth Busters #17: ERISA, Part I

We are almost up to 1992 in our Myth Busters series. So far we have dealt with:

All of this in just 20 years (1972‒1992). But we aren’t quite done yet. There were a couple of other things that happened in this period that had a profound effect on health care delivery and financing. One was ERISA and the other was the federal HMO Act. We’ll start with ERISA.

Jan 18, 2012 | 4 comments | by

Complex Systems, Part I

Visitors to John Goodman’s Health Policy Blog quickly realize that it’s different. For one thing, we have a sense of humor. For another, we understand that socialism doesn’t work. But the single biggest difference between our point of view and others in health policy — both on the left and the right — is this: Everyone who posts at our blog recognizes that health care is a complex system.

The single greatest health policy failing of the Obama administration is that it does not recognize this central fact. Neither Barack Obama nor any of his health policy advisors seem to understand what a complex system is, let alone how to develop public policies to successfully deal with one.

In this Alert, I will identify some of the properties of complex systems. In the following Alert, I will spell out some of the public policy implications.

I Can’t Tell You Why

Oct 19, 2011 | 17 comments | by

Why Are There Disparities In Health Care? Because It’s Free.

The latest issue of Health Affairs is devoted to racial and ethnic disparities in the consumption of health care. Naturally, they found some. Why are they there?

Let’s consider another necessity: food. Suppose you get a Double Quarter Pounder with cheese and a large order of fries, my favorite fast food indulgence when I put all considerations about healthy eating aside. Do you think your burger would have less cheese if you were a black customer? Would your fries be less crispy if you were Hispanic? Would the meat would be less juicy if you earned a poverty level wage?

The answer to these questions is obvious. Just about anybody in America can have the same fast food dinner anyone else in America is having — usually with very little inconvenience. If there is any disparity in this market, it is due solely to individual preference and choice.

So what makes health care different? I am happy to report that increasingly, it isn’t different. MinuteClinics, RediClinics and other walk-in establishments around the country offer standardized services that are comparable to the market for cheeseburgers and fries. In fact, almost one of every five people who got a flu shot last year got it at a supermarket or a drugstore. At a walk-in clinic, your flu shot costs the same as my flu shot. Your allergy prescription is just as inexpensive and just as accessible as mine. If there is any difference between us it is solely due to differences in needs and preferences. Nothing more.

The Failure of Orthodox Health Policy. So what’s the problem? Almost the entire health policy community is dead set against having medical care delivered in this way. The orthodox view is that (a) markets should be systematically suppressed, (b) medical care should be completely free at the point of consumption and (c) availability should be rationed by waiting and other non-price mechanisms.

Yet wherever the orthodox approach has been followed, disparities are rampant. The Inuit and the Cree in Canada, the Maori in New Zealand, Aborigines in Australia — all have less access to care and worse health outcomes than the majority white populations of those countries. (See the summary in Lives at Risk.)

Oct 12, 2011 | 28 comments | by
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