More good stuff from Cochrane on health care

I recommend reading John Cochrane’s op-ed in today’s Wall Street Journal, What to do when Obamacare unravels. It’s a great follow-up to my health care reforms.

Here are a couple quotes from Cochrane’s piece that addresses some common concerns over non-government medicine.

What about the homeless guy who has a heart attack? Yes, there must be private and government-provided charity care for the very poor. What if people don’t get enough checkups? Send them vouchers. To solve these problems we do not need a federal takeover of health care and insurance for you, me, and every American.

And (emphasis mine)…

No other country has a free health market, you may object. The rest of the world is closer to single payer, and spends less.

Sure. We can have a single government-run airline too. We can ban FedEx and UPS, and have a single-payer post office. We can have government-run telephones and TV. Thirty years ago every other country had all of these, and worthies said that markets couldn’t work for travel, package delivery, the “natural monopoly” of telephones and TV. Until we tried it. That the rest of the world spends less just shows how dysfunctional our current system is, not how a free market would work.

“I promise a chicken in every pot (chicken not included)”

Tyler Cowen was ‘somewhat surprised‘ to find out that a higher percentage of the uninsured disapprove of Obamacare. I’m not sure whether his surprise was that the disapproval wasn’t higher or lower.

I wasn’t surprised that more disapprove.

As I wrote in my “Wait…What?” post in July of 2012, Obama won votes by promising to solve the problem of the uninsured. Those voters didn’t realize that his solution would be to penalize the uninsured for not buying insurance.

It’s like the old Doctor joke.

Patient: Doc, it hurts when I do this. Can you fix it?

Doc: Yes I can.

Patient: Really? Great! How?

Doc: Stop doing that.

In July 2013, I didn’t think many people had made that connection, yet. I predicted they might when they had to pay the fine. They haven’t paid the fine yet, but are discovering that Obama’s solution was the same as the Doc’s above. Stop not buying insurance.

I offered what I think is a better medical mandate in this post (edited slightly).

If you choose not to purchase insurance and you need medical care, you will be expected to pay for your medical care.

Mine isn’t that much different than Obama’s. But, it doesn’t require government intervention.

Update: James Taranto, at the Wall Street Journal, does a great job of making my first point:

In short, what ObamaCare means to the uninsured who were not uninsurable is higher prices for a product they already were disinclined to buy, along with a punitive tax on not buying it. That seems more like a mugging than a benefit.

The Affordable Care Act?

1. Why didn’t the government just use eHealthInsurance.com instead of trying to recreate it?

2. You can go to eHealthInsurance.com now and compare available plans for 2013 and 2014.

I did. I found out that for 2013 plans for my family start at $152 per month. That is comparable to the high deductible plan that I currently have. I also have 58 plans to choose from.

I also found that Obamacare-compliant plans for 2014 start at $515 per month and I have 25 plans to choose from.  And, yes, that is for a high deductible plan.

Say what?

Is the cost of my insurance about to increase by $4,300 a year because of the Affordable Care Act?

I encourage you to give this a try. Go to the working website, eHealthInsurance.com and get rate quotes for you for 2013 and 2014. You only need provide a zip code, ages of the plan participants and whether each has used tobacco. It takes about 30 seconds.

Solving the wrong problems

I work with two contractors who are evaluating health insurance options because of Obamacare. They have been happy with their high-deductible, low premium insurance.

They are now discovering that the deductibles on their plans are too high to qualify as Obamacare plans and their insurance companies will not continue to offer them. They figure that changing to a lower-deductible, Obamacare-approved plan will increase their monthly insurance costs by $600 – $800 per month.

It seems I remember someone saying something like, if you’re happy with your insurance plan you can keep it (though, I guess not literally).

Two good ones from Greg Mankiw

I like it when well-respected Harvard economist, Greg Mankiw, gets snippy. In this post on his blog, he snips at Kathleen Sebelius’ lack of understanding of the the term insurance.

Also, I recommend reading Mankiw’s Sunday NY Times opinion column about what fiscal sustainability means.

This would have been nice to know

I love experiments. The results can be instructive.

In the Wall Street Journal, Merill Matthews and Mark Litow wrote about some health care experiments conducted in various states.

We compared the average premiums in states that already have ObamaCare-like provisions in their laws and found that consumers in New Jersey, New York and Vermont already pay well over twice what citizens in many other states pay.

I’ve written about insurance in New York before. Here’s one instance.

 

“I hope that works out for you”

Subtitle: Ideas are cheap; results matter

I’ve worked in many places that have an unhealthy incentive problem where ideas are rewarded and results are not.

People with fresh, new ideas were the movers and shakers. They could do even better if they could argue in hostile forums why their ideas would work  (folks who gain success at this are also called bullies).

The problem was that nobody asked these folks to prove their ideas with actual results.   Ideas won and lost by how passionately their champions fought for them and how good they sounded, not whether they worked or not. Often, ideas won out because the champions essentially repeated over and over, “I just know it will work! We have to try it.”

If your idea was selected by management, you were golden. If the idea later failed, there were plenty of excuses used. It was executed poorly. The messaging wasn’t right. It just wasn’t the right time. Rarely did the idea champions or the management who green lighted the idea ever just come out and say, maybe this just isn’t something customers value.

This environment generated lots of ideas and lots of infighting to get ideas selected, but not a lot of results.

I was never in charge, but I had the ear of some of the folks that were, once or twice removed, and I started a subtle campaign to curb this toxic, non-results driven, environment.

I suggested that the folks who had the ideas be responsible for proving them out with real world results and, since they usually felt with such passion that their ideas would work, I suggested they carry out their ideas within their own budgets. Why not? You are so sure it’ll work, put your money where your mouth is. If this will work so well, this should help you achieve your targets.

I coined a phrase, “You should give it a try. I hope that works out for you.”

The folks with the ideas use to win when someone in management would say, “Okay, we’ll try your idea.”  Now they started hearing, “You should give it a try. Let us know how it goes. I hope that works out for you.”

Suddenly, the folks with the great ideas were more open to criticism of their ideas and shooting holes in them before they got started proving them out, because they were more concerned whether the idea would actually work and less concerned if a few decision-makers in management would pick it.

I was reminded of this when I read a recent blog post on Arnold Kling’s askblog, The Left’s Post-Election Self Examination, where he comments on a leftist’s suddenly (post-election) more critical examination of Obamacare.

When Obamacare passed, it was easy for Democrats to claim victory that they had “fixed” health care. The actual results of their great idea wouldn’t be known until after the next election cycle, since that’s when it would start kicking in. They were like the folks at my work who got their idea selected by management.

One positive to this year’s election outcome is that many of the people in the Senate and the person in the White House responsible for passing Obamacare will still be here when the Obamacare realities begin to materialize and they may be held to account for the results of their great idea.

I wasn’t surprised to hear talk of Nancy Pelosi considering stepping-down as House minority leader shortly have the election. She’s probably thinking it would be good to get out of the spotlight before the Obamacare stuff starts to hit the fan.

Not surprising either that the leftist that Kling commented on is becoming more critical of Obamacare. This is what I saw happen to the idea-folks when they were faced with answering to the results of their ideas.

So, perhaps one unintended positive outcome of this election is that the American people are told the folks responsible for Obamacare, “Let’s give this a try. I hope that works out for you.”

What if it doesn’t work?

A moderate/liberal, but mostly uninterested in politics, friend of mine recently told me that he may not vote for Obama next week.

Why?

I’ve worked with this friend for years.

One thing I influenced him on over the years was the idea of emergent order. I pointed out that success stories are often a matter of random luck and the best way to ensure a company’s success is to try as many of the happenstance of random luck as possible.

We saw it over and over at our business. Many things that seemed like they should have worked, didn’t. Some things that seemed like they shouldn’t have worked, did. Many of those things were discovered by accident.

I pointed out to him that centralized management and politically powerful constituent groups in the organization stifled the emergent order that is evolutionary, random, experimental discovery. Stifling that process led to lackluster results — unless the company happened to be very lucky.

My friend said health care was the issue that made him reconsider his presidential vote. Obamacare is a centralized system that will stifle discovery and innovation. It doesn’t allow us to experiment with plans B, C, D, etc. if Plan A doesn’t seem to be working. It only allows for us to keep tweaking Plan A — which puts us on the same path as a mature company that can only manage to tweak its core products, rather discover new ones.

My friend has seen Plan A not pan out enough times that he thought Romney’s approach of letting the states experiment seemed to make more sense.

I don’t know if he will follow through, but it’s good to know that I’ve at least caused him to think about it.

Pathologies of the health care system

Another good op-ed from John Cochrane in the Wall Street Journal about health care, What to Do on the Day After Obamacare.

Cochrane agrees that many of the problems in health care are caused by previous government meddling:

Most pathologies in the current system are creatures of previous laws and regulations.

And, he again writes eloquently on how these previous laws and regulations distort the medical care and health insurance markets to cause the very pathologies that Obamacare supporter think more regulation will fix.