Cato-at-Liberty has some harsh words for Jon Chait:
For those who think that it’s just conservatives, such as Ann Coulter, who are mean-spirited, they should check out the new book by Jonathan Chait, a senior editor of the New Republic, entitled The Big Con: The True Story of How Washington Got Hoodwinked and Hijacked by Crackpot Economics.I managed to get through the introduction and first chapter of Mr. Chait’s book. Alas, I could read no more. Here are some of Chait’s characterizations of supply-side economists and supply-side economics–from the 1970s to the present day–in those first 44 pages:
“Pseudo-economists”, “cult of fanatical tax-cutters”, “amateurs and cranks”, “patently ludicrous ideas”, “preposterous ideas”, “theological opposition to taxation”, “ideological fanatics”, “insane”, “detachment from reality”, “extremism of their agenda”, “triumph of the extreme”, “a cult”, “quasi-religious”, “totalistic ideology”, “crank doctrine”, “sheer monomania”, “plain loopy”, “magical”, “sheer loons”, “deranged”, “wingnuttery”, “utterly deluded”, “crackpot economic theories”, “lunacy”, “ludicrous,” etc.
You get the idea.
One of the worst features of modern political discourse is the inability of critics to distinguish between being crazy, and being wrong. The supply siders of the 1980s were not crazy (Jude Wanniski and George Gilder notwithstanding); they were simply incorrect. The supply-siders of later vintage believed, on very flimsy evidence, that tax cuts raised tax revenue, for the same reason that progressives believe, on what to me looks like very flimsy evidence, that their national health care program will be the first American health care program in history to realize net cash savings: it is much nicer if the things you earnestly long for do not involve any tradeoffs. Unfortunately, this is almost never the case*.
I've recounted elsewhere my experience with supply-side dogmatism at a conservative publication; it's both shocking, and deeply wrong. However, that doesn't make Jonathan Chait right. Even as I wrote that, Ramesh Ponnuru of National Review was writing this about the New York Sun:
Presumably what they mean is that the top income tax rate is higher than the revenue-maximizing rate, but I'm not sure why they think that it is. Bush's tax cuts appear to have caused revenue to be lower than it would otherwise have been, which suggests that we're already below the revenue-maximizing tax rate.
Which suggests that hard-core Lafferism isn't quite the monolithic dogma that Chait suggests.
Broadly, that's my biggest problem with the book: it's so terribly simplistic that you can't really learn anything interesting about the Supply-side movement, or Republican economic policy, except that Jonathan Chait hates them. Except I didn't really need a whole book to tell me that; two minutes with one of his articles is more than enough to convey Jonathan Chait's searing contempt for all those who disagree with Jonathan Chait.
Large swathes of economic history are left out, or their implications ignored, because they don't fit Chait's cartoon version of evil rich people swaggering about in top hats as their lackeys on K Street and in the think tanks cravenly put one over on the good and great American people. And he makes truly embarrassing errors that seem to indicate that he hasn't really mastered the economic theories he's dismissing, which makes one disinclined to trust the rest of the book. The result is a work that is, as Cato's poster notes, venomous--but without the usual compensating virtue of being amusing.
* The fact that Europe has generally longer lifespans than America at lower cost is multi-factorial, with the health care system the least important--or perhaps irrelevant--variable lost in lifestyle, crime, genetics, and even the way that statistics are collected dwarfing the role of health care. Likewise, on the cost side, there is an extreme degree of path dependence in the mechanism that allows French doctors to, for example, make less than an experienced RN in the United States, and other than slashing pharmaceutical payouts, which account for a trivial percentage of US healthcare spending, and moreover, save money on other procedures, no one has offered a plausible political mechanism by which the US could get there from here.
"The fact that Europe has generally longer lifespans than America at lower cost is multi-factorial, with the health care system the least important--or perhaps irrelevant--variable lost in lifestyle, crime, genetics, and even the way that statistics are collected dwarfing the role of health care. "
Are there any studies supporting the statement that health care is relatively unimportant as a determinant of longevity? And please don't quote John Stossel.
"The supply siders of the 1980s were not crazy"
Care to tell us why they were not crazy? Or are you going to rebut Chait's claim by saying 'nut uh'?
The fact that Europe has generally longer lifespans than America at lower cost is multi-factorial, with the health care system the least important--or perhaps irrelevant--variable lost in lifestyle, crime, genetics, and even the way that statistics are collected dwarfing the role of health care.
Here we go again. That is a monumental claim supported by absolutely no evidence that you've deigned to supply us with. That's just such a basic lack of rhetorical rigor, it boggles the mind.
But I'm just a basher! A liberal loon! I criticize McArdle because she's a woman!
Those plucked-from-context phrases are supposed to be the lefty rhetorical equivalent of Coulter?
Really?
Wow.
That's like comparing a jaywalker to a murderer. Both are illegal, after all!
Reading Megan is what finally made me understand the concept of truthiness.
Stan,
All the big gains in longevity occurred before the modern era of high intensity medical care, like cancer treatments, most of your man-made pharmaceuticals, and heart bypass surgeries. The two advances in medicine that surely propelled a lot of this were the advent of vaccines and antibiotics (but these are available everywhere in the western world, not just universal care countries). This is a historical fact. People also started living longer because food became more secure and nutritious, we developed better hygienic conditions on a wide array of fronts due to better engineered cities and homes, and our work was less physically taxing (however, we have, ironically reached, possibly, the downside of this change due to excess inactivity). Longevity has been in the long, flattening stage for the last half century. Barring a breakthrough in the controlling, at the cellular level, the rate that one ages, we will probably top out around the late 80s to early 90s.
The things that lower Americans' longevity are deaths due to violence, accidents of all kinds, and things like obesity and physical inactivity. If Americans didn't kill each other more than others, die in accidents more than others, or eat more profligately, our longevity would likely be smack in the middle of the western European countries. As it is, we are only a year or two behind the countries most like us in an ethnic sense.
I think we spend too much on medical care, but then, being a frugal kind of person by nature, I think we spend too much on a whole host of goods and services. But, then, I don't feel an impulse to pass laws preventing people from doing that.
Why that book continues to get 'air time' is beyond me. It will soon be in the 99 cent bin next to McCain's latest polemic and Theresa Heinz Kerry's books. A book written on an economics topic by a political writer.....hmmm, would also be a book purchased by someone who wants to read something that won't challenge their already-made-up-mind. Mind you I have the same issues with Laffer as most do, but why the hell would I pick up Chait to get more illumination on the topic?
Yancey, I don't agree with you that violence and accidents account for the shorter life expectancy here in the States. Yes, we have more violent deaths here than in Europe, but not enough to tip the balance. You're on stronger ground regarding lifestyle choices, but I'm not sure that the current epidemic of obesity in America has lasted long enough for public health experts to know for sure what its effects have been on longevity. And then there's the fact that Europeans smoke more than Americans. What effect does that have? And finally, the high infant mortality in the States, due, in large part, to our exceptional minority population poverty rate, must play a role. As many social scientists have noted, there's nothing in western Europe that resembles the third world conditions in American cities. So, the bottom line for me is that I don't know what causes our poor health as compared to Europe. And I don't think Megan knows either.
Freddie, it's very well supported. Go ask your local epidemiologist which will make your population live longer: government-provided diabetes treatment, or having a population that doesn't get diabetes in the first place; widely available statins, or having a population with fewer problems with hypertension . . . etc., etc.
America's health care statistics are crushed by
a) violent crime
b) genetics (blacks and native americans have worse health care outcomes on a number of variables even when you control for income, education, and health care access; hypertension, alchoholism, and diabetes kill these groups much younger than whites.)
c) lifestyle -- our poor diet and excercise give us killer diseases like diabetes at much higher rates than healthier places.
d) Possibly some other "x" factor, such as status disparities or stress
Access to health care doesn't seem to be a very important determinant; a recent study showed that as long as you go to the doctor once every few years, being uninsured has no effect on health outcomes. Access to health care frequently shows up as an important variable in studies that don't control for things like income and education which, for reasons that aren't clear, are major contributors to health.
Really, it isn't at all controversial that American lifestyles are driving much of the difference between our health statistics and, say, Japan's; nor is it controversial that some minority groups have poor health care outcomes that persist even after you control for the worst effects of minority status, such as income and education. Nor is it controversial that our murder rate drives a substantial portion of the difference in mortality rates. You can look all these things up yourself; I suggest you do so before shouting that I don't know what I'm talking about.
Bush's tax cuts appear to have caused revenue to be lower than it would otherwise have been, which suggests that we're already below the revenue-maximizing tax rate.
What?! I thought tax revenues were higher under Bush. "Otherwise would have been"? How does one measure such a thing? Surely taxes are a disincentive to investment/labor. The optimal tax rate (for revenue generation) must be somewhere between 0% (no taxes = no revenue) and 100% (no incentive to produce anything => no tax base => no revenue). But how does one go about pinning down the exact value? An increase in revenue over previous years means at the very least the tax cuts couldn't have been that harmful even in the worst case.
In most other countries, babies that are born premature or who die within 24 hours are not considered live births. In the US, we consider just about any baby that makes it out of the womb with a pulse as being a live birth. So really, really sick babies who die in the US are counted as infant mortalities while in other countries, they are not.
This stuff isn't hidden or particularly obscure. You can't compare infant mortality rates when they don't mean the same thing.
EI
Megan and Yancey are without a doubt correct on the relationship between lifespan and healthcare system. Liberals should acknowledge this; not doing so really does smack of truthiness. I favor French or Aussie-style national UHC not because I think it's going to enable Americans to live longer (I don't) but because it will help them to live better (ie., they'll realize a net gain in utility). I also think we'd likely see some positive economic side-effects if we get it right.
Megan: I think where most liberals see the savings is down the road. The reasoning, in other words, is that, with some form of well-managed universal healthcare, the US will only spend, say, 19% of GDP on healthcare in 2023 rather than the, say, 24% of GDP we'll be spending if we fail to enact major reforms. This may or may not be correct, but I don't think the logic is all that crazy given the fact that the non-UHC US spends more than any other rich country on healthcare.
I would also add that it's possible that our income tax rates are on the left side of the Laffer Curve, but our capital gains, corporate, and estate tax rates are not.
Jasper, when you referred to "non-UHC America", I thought you meant Americans not covered by United Healthcare.
So, you made an accidentally brilliant point, I suppose.
Earnest Iconoclast,
Probably the best way of comparing infant mortality in the US and western Europe is to look at neonatal mortality, the number of infant deaths in the first 28 days per 1000 live births. In contrast to infant mortality rates, there is no ambiguity in comparing US neonatal mortality rates with those of other countries.
A few minutes of internet research took me to this url,
www.who.int/healthinfo/statistics/indneonatalmortality/en/
which gives neonatal mortality rates of 1 in Japan, 2 in Belgium, 3 in the Netherlands, the UK, and most of the rest of western Europe, and 4 in the US.
Most experts feel that our awful neonatal mortality rate is due in large part to the high percentage of low weight newborns in the US. One of the features of American life is that we don't provide support to expectant mothers in the sense of nurse's visits, time off with pay, income support, and nutrition and lifestyle counseling that they do in western Europe.
I suppose in a certain sense this validates Megan's claim that health care is unimportant. But it doesn't say much for her feeling and yours about the uselessness of a "nanny state". Or am I misunderstanding your point of view?
As usual, the Megan crowd seems to ben unable to make the more sophisticated distinctions commonly used in such esoteric matters as, say, ordinary business root cause analysis.
To summarize the statements as I have read them:
1. The US does spend more on health care as a % of GDP the the EU
2. The EU DOES have better health care outcomes
3. It is known that lifestyle choices have --in most cases -- statistically greater coefficient of correlation with health care outcomes than health care delivery systems. (By the way, I am accepting this statement as plausible. I have yet to see any hard studies showing under what conditions this statement is true, and what its limits of applicability are.)
So say thank you, I just gave you a pass.
From these statements, it becomes POSSIBLE that EU lifestyle choices or genetics are better than American ones. Megan provides absolutely NO evidence that this is the case. After all, as was pointed out, smoking and second hand smoke exposure occurs at a higher incidence.)
This reminds me of the sort of
"quasi-rational" statements made by so-called "New Age" healers.
You know, the 19th century scientists and scientific philosophers spent quite a lot of effort on perfecting scientific method to avoid confusing POSSIBLE explanations from PROVEN ones.
You should try it some time. It's not really as painful as you fear.
Stan,
There is overwhelming evidence that health care plays only a minor role in determining the mortality and morbidity of national populations. See this piece for references to some of the research in this area. You should read the whole article, but the following quote seems particularly relevant:
Unfortunately, proponents of "universal health care" invariably seem to have a grossly, grossly exaggerated view of the relationship between health insurance (or "coverage"), health care, and health.
Stan, this fails to address the Earnest Iconoclasts's concerns about stat-gathering in infant deaths. If the U.S. counts live births starting from womb-exit, but other countries start after the first 24 hours, then the first 28 days will not look the same. Unfortunately, the link you provided does not break out "late neonatal" results - what happens between 7 days and 28 days - which *would* be a valid basis for comparison.
Tim Connor,
The EU DOES have better health care outcomes
I'm not sure what this statement is even supposed to mean. By "better health care outcomes," do you mean a higher rate of successful treatment of health problems? A higher rate of successful diagnosis of health problems? Or what? And whatever your definition of "better health care outcomes" is, please present the evidence that you believe substantiates your assertion of "better health care outcomes" in the EU than in the US.
The remarkable coincidence of Ponnuru's post and your experience having happened at approximately the same time notwithstanding, his post was extremely unusual. And I don't see how the coincidence "suggests that hard-core Lafferism isn't quite the monolithic dogma that Chait suggests", as you write. Neither the coincidence or what Ponnuru wrote suggest anything about "hard-core Lafferism", as far as I can see. Unless you mean he is a hard-core Lafferite who nevertheless disagrees with other hard-core Lafferites on an important point.
Chait seems to have gotten under your skin; I've read a number of his articles without getting any sense of "searing contempt for all those who disagree with Jonathan Chait."
Seconded. Chait's comments are not comparable to the bloodlust evinced in Coulter etal.
The WHO defines the perinatal mortality rate as the normalized number of deaths of fetuses and infants in the period starting at 22 weeks of pregnancy and ending 7 days after birth. According to Table 6.1 in
http://tinyurl.com/yuxt76
the perinatal mortality rate is 6 in Australia, New Zealand, and western Europe, and 7 in North America. According to
http://tinyurl.com/2f372c
the perinatal mortality rate in Canada is also 6. So, I stand corrected a little bit. We're worse than developed countries with universal medical coverage, but only about 15% worse. It's something we should all be proud of.
On another line of argument, the one that says that medical care isn't all that important in determining longevity, I remain dubious. Insurance companies routinely pay for pelvic exams, mammograms, fecal blood sample tests, colonoscopies, tests for high cholesterol and diabetes, EKG's, and other diagonostic procedures. Are people here really arguing that this is a waste of money?
Stan, you have to correct for genetics; african americans have, for unclear reasons, much higher rates of preterm and low-birthweight babies than whites. Factor that in, and we're about average.
Megan, I know about the problem with African Americans. It distresses me, because I think we should be pouring more resources into providing low income women of all races with access to medical care and by interventions in the form of prenatal counseling and financial support for expectant mothers. Obviously we disagree about what's moral and what isn't when it comes to public policy.
Stan, the differences, as I said, persist even after you control for income and health care access. Black women outside of the inner city with good jobs and benefits still have higher rates of preterm labor, and tend to have premature babies earlier than white women, both of which make for much worse outcomes. We don't know what the solutions are, but health care access isn't the main problem.
Stan, where did Megan say we should not be putting more resources into pre-natal care for at risk mothers? Her point is that overall, the variations in life expectancy between similar western countries are not that closely correlated to differences in access to healthcare.
You should really pay attention to the discussion before posturing about what is "moral".
The usual sloppy thinking by sf readers who think they're smarter than anyone else. Statistics have been offered up by one side, Chait, et al, and some posters (for example, how who determines perinatal deaths) to support their position. I have seen no statistics offered up by the other side, only vague pronouncements that other factors skew the estimates of the benefits of various health care programs.
Guys, how about a little application of, you know, the scientific method? How about supporting your claims with evidence, making some testable predictions, that sort of thing. For example, if it's really the statistics for African-Americans that negatively skew the results for outcomes in the U.S., how about providing data to show the relative mortality of this subgroup in the developed countries while correcting for income disparaties, profession, etc?
Instead of just throwing out a speculation that the other side then has to convince you is not true (and _you_ get to decide! How . . . convenient.)
Arguing by analogy, making claims that the other side has to disprove . . . that's not what 'smart' people do. Or honest ones, if they know better.
here's a link to the piece in health affairs alluded to earlier (if you have access with an institutional subscription).
http://content.healthaffairs.org/cgi/reprint/21/2/78
As Megan says, this is not rocket science, more like public health 101.
a few excerpts
For the population as a whole, the most consistent predictor of
the likelihood of death in any given year is level of education; persons
ages 45–64 in the highest levels of education have death rates
2.5 times lower than those of persons in the lowest level.16 Poverty,
another strong influence, has been estimated to account for 6 percent
of U.S. mortality.17 The observation also has been made that
each 1 percent rise in income inequality (the income differential
between rich and poor) is associated with something on the order of
a 4 percent increase in deaths among persons on the low end,...
Behavior patterns represent the single
most prominent domain of influence over health prospects in the
United States. The daily choices we make with respect to diet,
physical activity, and sex; the substance abuse and addictions to
which we fall prey; our approach to safety; and our coping strategies
in confronting stress are all important determinants of health....In all, behavioral choices account for at least 900,000 deaths annually,
of which more than 40 percent (and all of them, by definition)
are early deaths,...
A long-standing estimate by the Centers for Disease Control
and Prevention (CDC) places the contribution of health care
system deficiencies to total mortality at about 10 percent.33 Thus,
even if the entire population had timely, error-free treatment, the
number of early deaths would not be much reduced.
On a population basis,
using the best available estimates, the impacts of various domains
on early deaths in the United States distribute roughly as follows:
genetic predispositions, about 30 percent; social circumstances, 15
percent; environmental exposures, 5 percent; behavioral patterns,
40 percent; and shortfalls in medical care, 10 percent.
I didn't think Megan's political stance is immoral, and I'm sorry about what I said in my response to her post. But I agree with ScentOfViolets. I am unable to find any actual data that shows why our public health policy makes sense from an economic point of view. All I see from the libertarians is boiler plate about hollow-eyed medical refugees from Canada lining up to cross the border, coupled with an aversion to discussing in practical terms why the medical insurance plans proposed by Clinton, Edwards, and Schwarznegger are so awful. I also don't see any explanation of why the Dutch, the Germans, etc. don't simply chuck their medical plans in favor of ours if their systems are so awful. Are they too stupid to see their own best interests? C'mon guys, enlighten me.
I also don't see any explanation of why the Dutch, the Germans, etc. don't simply chuck their medical plans in favor of ours if their systems are so awful. Are they too stupid to see their own best interests?
Are we?
In the US, we have insurance that often shields us from the costs of our care (fixed co-pays for office visits and medication, low deductibles, etc...) and we typically have a lot of freedom to choose our providers and treatments (within a set given by our insurance company). This means we are making choices but not having to consider the cost impact. I'd rather see us try a system where we paid a percentage of the cost or use some other mechanism to encourage making cost-effective choices before we go to a centrally managed/controlled system.
If 40% of our mortality/health is driven by behavioral choices, then we should probably be spending more money on education (which also helps outcomes). I don't know the actual numbers, but there are people out there who don't understand the consequences of sex, for example (pregnancy and STD's). Perhaps if we were, as a country, better educated, we'd make better choices.
On the other hand, perhaps the "bad" decisions we are making are really the ones we want to make...
If I have time, I'll try to find some statistics comparing the late neonatal mortality rates for people of European descent in the US vs. Europe. That would be a true apples-to-apples comparison.
EI
Paul, every poll I've seen says that Americans favor universal medical coverage by a two to one ratio. The reasons we don't have it, in my opinion, are a) it's not a matter of vital concern to the majority of the population, b) the people who don't like social welfare programs are truly passionate in their opposition, and c) corporate interests, particularly the insurance industry, contribute heavily to politicians who favor the status quo. For what it's worth, I think that the one third of Americans who object to universal coverage plans have some good points. They're afraid that a single payer system would turn out to be more restrictive in terms of coverage than their own plans, and many of them feel that they shouldn't have to subsidize people who ought to care for themselves. I share these feelings to some extent, and in the end I opposed the 1994 Clinton health initiative. The present Clinton and Edwards plans seem sensible to me, primarily because they aren't single payer but still achieve universal coverage.
Without defending the current system too much, my major opposition to much (but not all) of the UHC programs I've seen is that they eliminate the incentives to improve medical technology.
I worked for several years at a company that was developing a medical device. The device was not a lifesaving thing, it provided an improved quality of life. The business model was entirely built around the US market.
This doesn't mean that Europeans couldn't purchase it; they could (and they got it sooner to boot...EU market approval (CE Mark) is much easier to get than FDA approval). But there is not sufficient profit in the European market to justify the business, only the American market provides that.
This of course meant that, at least initially, only rich Americans (but all Europeans...) would have access to the improved quality of life, but the nature of technology is that it will eventually be cost reduced and becomes more and more accessible. I like this outcome better than the alternative, where it's never available to anyone because there's no incentive to create it in the first place.
I don't get the sense that single-payer advocates recognize the longer-term trade-off they're making by eliminating incentives. The European free-riders don't help matters, by making it look like you can have it all. But I don't believe that a single-payer system reduces net human suffering when measured on a generational timescale; I think it increases it.
So the fact that we are on the other side of the Laffer curve suggests that we should raise taxes to eliminate the deficit, and expect less of a reduction to GDP, then the amount raised, Correct?
Stan (and ScentofViolets),
I just pointed you to an article with reams of data indicating that health care has little to do with health and longevity. Please read it.
Remember, "universal health care" is not so universal. In Canada, prescription drugs, dental care, & eye care, are not covered, and these account for the normal healthcare costs of most people. Many newer treatments are not covered. There are waiting lists, but if you have connections (or if money changes hands), you can jump the queue. Also, the healthcare system is heavily unionized, and subject to strikes.
This kind of system is much cheaper (9% GDP Canada vs. 14% GDP US), but in the end this does not affect lifespan as a whole.
Megan,
You are usually VERY careful to use terms correctly. I believe you are not defining the Laffer Curve correctly.
The Laffer Curve is a reality, at least for all double-digit tax rates.
That does NOT mean that tax cuts will always increase government revenue. It ONLY means there are diminishing marginal returns in terms of tax receipts as you increase marginal rates. At some point, tax revenue actually declines.
That's it. That's the Laffer Curve.
Example:
If a government raises $20 in revenue with a 20% tax, it may only collect $27 in taxes from a 30% tax.
Here's the BIG implication:
GDP was $100 under the 20% tax rate.
GDP drops to $90 under the 30% rate.
Even though tax receipts grow considerably, there is deadweight loss to the broader economy. The private sector was $80 under low taxes. It shrinks to $63 under high taxes.
In the super-long term, GDP growth dominates all other factors for tax receipts. However, in a 10 year planning horizon, tax hikes may indeed boos tax revenues.
However, it does so inefficiently at significant harm to the economy.
Exactly how much should be the source of reasoned debate.
Mixner, I read the article you suggested, and I'm not sure it's definitive. For example, the article
http://www.milbank.org/720203.html
written in 1994, says " An aggregate effect of medical care on life expectancy is found to be roughly five years during this century, with a further potential of two years."
Who am I to believe? My own feeling, based primarily on personal experience, is that good medical care improves your health and extends your life even if your genes say otherwise. I realize this is a personal preference, and if you decide to forego medical care for the rest of your life on the grounds that it really doesn't matter, I applaud your adherence to principle.
stan,
written in 1994, says " An aggregate effect of medical care on life expectancy is found to be roughly five years during this century, with a further potential of two years."
You're making my argument for me. Average life expectancy in the U.S. increased from 47 in 1900 to 77 in 1994. Of those extra 30 years of life, only 5 (according to the study you cite) can be attributed to improvements in medical care. Other changes (safer food, cleaner drinking water, less air pollution, safer working conditions, etc.) are responsible for the other 25. Again, this illustrates how relatively unimportant medical care is to the health and longevity of a nation's population.
And I'll bet a huge share of those 5 years attributable to medical care came from just a handful of low-cost, high-benefit innovations, such as mass childhood immunization against common infectious diseases (which dramatically reduced the infant/child mortality rate), and widespread use of low-cost antibiotics like penicillin that are already widely available even to Americans with no health insurance. All of the high-tech, high-cost medical innovations of the last several decades combined have probably had only had a very small effect on average life expectancy.
Mixner:
The "better health care outcomes" that Megan 's --and many others --speculations purport to explain are usually summarized in a variety of benchmarks --lower infant mortality, longer life expectancy, etc.
It is quite possible that the many speculations placed upon this page DO explain the differences, thereby conclusively demonstrating that the presence of National Health care systems in these countries has no positive effect. My comment, however, is that they have done almost nothing to demonstrate it. In this fashion, their behavior is more or less identical to the much reviled Mr. Chiat.
Your comment appears to question whether --in fact --there ARE better overall health benchmarks in Europe. This is sort of like continuing to support the Laffer curve. Suit yourself. I subscribe to Moynihan's comment, paraphrased roughly as "everyone is entitled to their own opinion, but not their own facts.
I cannot resist asking however --why would Megan and company be providing endless speculations to "explain" that these benchmarks are not affected by the health care system if they didn't exist?
Tim Connor,
The "better health care outcomes" that Megan 's --and many others --speculations purport to explain are usually summarized in a variety of benchmarks --lower infant mortality, longer life expectancy, etc.
But, as has been explained to you over and over again, aggregate health and mortality statistics (infant mortality rate, etc.) do NOT represent "outcomes" of a nation's "health care system." They don't tell us anything about how good the nation's health care system is at preventing, diagnosing or treating illness and injury. They are simply indicators of the health of the national population. They tell us nothing whatsoever about what determines that level of health.
We know from overwhelming evidence (not "speculations") that cultural, political environmental, and behavioral factors vastly outweigh the influence of health care on rates of disease and premature death. Smoking alone is estimated to cause over 400,000 premature deaths a year in America. This is more than twenty times the number the Institute of Medicine estimates to be caused by inadequate health insurance.
Your comment appears to question whether --in fact --there ARE better overall health benchmarks in Europe.
No, I'm asking you to produce evidence of "better health care outcomes" in the EU. That is, evidence of better rates of successful prevention, diagnosis or treatment of health problems by the health care systems of EU nations. Do you have any such evidence or don't you?
"But, as has been explained to you over and over again, aggregate health and mortality statistics (infant mortality rate, etc.) do NOT represent "outcomes" of a nation's "health care system." They don't tell us anything about how good the nation's health care system is at preventing, diagnosing or treating illness and injury. They are simply indicators of the health of the national population. They tell us nothing whatsoever about what determines that level of health."
I reiterate --these staements have been made without any kind of rigorous methodology. Consequently, they are no more substantive than staements that the health care system system DOES have an affect.
I DON'T know what the coefficients of correlation for public health actually are. But I also doubt that you do, no matter how many times you religiously "explain" things to me. The Republican presidential candidates all state that tax cuts raise federal revenues. That HAS been empirically proven to be false.
So mere repetition of the party line does not impress me.
There is no doubt that genetics, lifestyle, and other factors affect public health. Anyone who does root cause analysis for a living is familiar with the phenomena of complex causality.
In fact, it is this experience that makes me more than a little suspicious of your glib assertions that a public health system has NO impact public health. In particular, it seems plausible that a system where perhaps 15% of the population has totally wretched access to both ongoing health care and coaching MIGHT have a definable coefficient of correlation with health care outcomes.
If you have access to solid study numbers on this specific subject --not merely demonstrating the existing of complex causality regarding health outcomes --feel free to provide them, and explain them to me.
Otherwise, you are just repeating your prejudices, and the speculations that support them.
Tim Connor,
I reiterate --these staements have been made without any kind of rigorous methodology.
Huh? You're the one claiming that aggregate health statistics (infant mortality rate, average life expectancy) are meaningful indicators of "health care outcomes." It's up to you to present your "rigorous methodology" supporting this claim. You haven't done that. You haven't shown that there's any statistically significant relationship between them at all, in fact.
And if you can't show any such relationship, there's no reason to believe that infant mortality rate, average life expectancy, etc. tell us anything meaningful about the quality or effectiveness of a nation's health care system.
What you need to make your case is data showing, for instance, that EU health care systems are better at diagnosing or treating, say, breast cancer, or heart disease, or diabetes than the US health care system is.
Do you have any such data? I didn't think so.
Tim Connor,
... your glib assertions that a public health system has NO impact public health.
I never said that.
In particular, it seems plausible that a system where perhaps 15% of the population has totally wretched access to both ongoing health care and coaching MIGHT have a definable coefficient of correlation with health care outcomes.
You are aware, I assume, that "no health insurance" does not mean the same thing as "no health care." Just how much health care does the average uninsured American receive in comparison to the average insured American? Do you know? No, of course you don't. You're just making things up, yet again.
Mr./Ms. Mixner:
I am perfectly aware that I am wasting my time, since your modus operandi appears to be on the order of "Nyah, Nyah".
However, I did not state that governmental schemes for public health care had been rigorously demonstrated to improve health care.
I stated that the positions taken by Megan and her supporters, with a variety of non-rigorous attributions to other health outcome factors, such as lifestyle and genetics, had NOT convincingly proved that public health care systems had NO effect on health outcomes.
Frankly, although it may be true, it is by no means a no brainer. For example, one would think, in a rational market, such a reality would cause the market for health care to shrink.
Nonetheless, what you are saying MIGHT be true. It definitely has NOT been PROVEN by any rigorus methodology based the statements made in this blog.
Since this is a topic of general interest --if only because of the percentage of GDP health care consumes --one would think one would like to see the issue rigorously investigated.
What I find irritating about both Megan's post and yours is your willingness to substitute loose speculation for investigation, and your attempts to denigrate anyone who finds such loose musings less than fully convincing.
Have a nice time feeling right.
Regards.
Getting away from health care and back to the issue of whether Jon Chait is nasty: the claim that cutting taxes raises more revenue (for tax rates less than 50%, anyway) has been known to be false since, at the latest, the mid-80s, when Ronald Reagan and his henchmen admitted failure and raised taxes -- presumably in the expectation of increasing, rather than decreasing, revenue.
In what year did a continued insistence that cutting taxes would raise more revenue stop being "wrong" and become "crazy"?
Only a tiny group (Wanniski, Gilder et al) initially embraced the supply-side gospel. Most economists felt they were practicing, in George Bush Sr.'s memorable phrase, "voodoo economics". So a lot of people apparently thought this idea was crazy. If I think an idea is crazy, and it turns out to be wrong, was it slanderous of me to initially call it "crazy"? No one has ever tried running a car on orange juice; sounds crazy to me. If you try it, and it doesn't work, was my initial use of the term "crazy" akin to the hate speech of Ann Coulter? How about thirty years later -- what do I call people who still think you can run a car on orange juice, if you just give it enough time?
Note, also, that this is strikingly similar to the way that opponents of the Iraq war feel about the narrative of that idea: we told you it was crazy; it turned out to be a disaster; and now we're supposed to respect your seriousness???
I thought the idea that cutting taxes would increase revenue was crazy when Reagan first ran on it -- and I was 11 at the time! I thought that George Bush guy sounded a lot more reasonable. Did I lack the expertise to make such a judgment, the access to special knowledge possessed by the likes of Jude Wanniski? Maybe. But guess what? Turned out I was right: the budget deficit exploded. So then I thought, okay, my instincts to trust the more reasonable sounding people, like Carter, Anderson and Bush, were correct. And yet, as the years have gone by, and the decades, it seems we keep hearing the people who were wrong in 1980 coming back and saying no, they weren't really wrong at all; it was this, it was that, the idea is in principle undeniably sound. And they keep acting on that idea, time and again, cutting taxes over and over on a theory I thought sounded nuts when I was 11 and that has been getting proven wrong with clockwork regularity throughout my adult life!
So what am I supposed to call the people who still believe in it? Please, suggest a term. "Ludicrous crackpots"? Sorry -- too polite.
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