Big Business: A Love Letter to an American Anti-Hero

Tyler Cowen tries to argue in his latest book Big Business that big businesses are in reality not the villains they’re often made out to be and, in fact, deserve our praise. While the book presents strong counter-intuitive arguments about the good that big business does in America, I suspect readers skeptical of large private enterprise will walk away unconvinced. In the big picture, critics of big business are still likely to assume that some combination of more regulation, smaller businesses, and public ownership would be a superior alternative to the status quo.

In a huge ecosystem of large corporations, Cowen emphasizes that a fair assessment needs to look at the “net net” of the total impact of big business and not just the worst offenses. Cowen acknowledges the salesmen swindling low-information customers, dentists recommending more appointments than necessary, and pharmaceuticals striking shady deals with doctors to dish out addictive drugs. But his underlying thesis is that we need to look at the net effect.

The Good

While admitting these egregious offenses, Cowen claims “the propensity to commit fraud is essentially just an extension of the propensity of people to commit fraud.” He points to a survey showing that 53% of people admitted to lying in their online dating profile. One study estimated that we tell an average of nearly two lies per day and most often those are to people we are the closest to and not total strangers. Another showed 31% of people having completely fabricated information on their resumes and 76% “embellished the truth.” Indeed, when we look at big business in the modern economy we often evaluate things as they are and think of alternatives as we wish to be. It’s worth considering the possibility that big business is no more dishonest than we are as individuals.

In fact, Cowen argues that big business is incentivized to be even more honest than individuals or small companies. Because they have an (inter)national brand to uphold, big businesses are more incentivized to avoid the PR disasters that come from customer negligence in a world of viral social media. Further, there is evidence big businesses are more likely to treat their workers better than their mom-and-pop counterparts.

The NFL can shamefully exclude Colin Kaepernick because of his politics, but often overlooked is the idea that the profit motive can be a positive force for social justice. Cowen points to our national reckoning with sexual assault to argue that private business can be a better force for good in these regards than the public alternative. Allegations against men in the entertainment industry were met with swift action – think of Kevin Spacey, Jeffrey Tambor, etc. – while a man with a long history of unambiguously immoral treatment of women sits in the Oval Office. Roy Moore only barely lost in the Alabama Senate race. Market forces can be seen as a villainous determinant to cut corners and exploit people unfairly, but it can also be a force for social justice under some circumstances. As Sam Hammond argued in Liberal Currents, corporate capitalism and social justice are not always opposing forces.

Too many arguments in favor of scrapping the entire system assume that a radically redefined economic system and culture will mold to their ideal reality. But what happens when we put government in control of every industry and Donald Trump is the one running that government? Fox News is an easy target for the ills of profit-driven media, but would an entirely publicly-owned media landscape just mean Trump hires Roger Ailes to run PBS?

Cowen spends the majority of the book tackling the common criticisms of big business: CEO pay, the financial industry, big tech companies, and corporate influence over government. The gravity of these statements need to be analyzed through his “net net” framework and does add counter-intuitive arguments to the conversation, even if not always entirely convincing.

CEOs today work in a more demanding environment, he argues, needing to steer through a globalized economy full of public relations issues, foreign investment, and regulatory know-how. How important is leadership to a company’s performance? The top 4 percent of corporate performers are responsible for the entire increase in the U.S. stock market since 1926. Cowen offers evidence that these higher demands are borne out by higher performance. For example, Chinese firms could improve their productivity by 30 to 50 percent by bringing management quality up to the standard of Americans, Indian firms 40 to 60 percent. One study says a company’s leader accounts for 5 to 6 percent of the value of a company. Under this backdrop, Cowen believes higher pay is warranted under the greater demands.

An important stylized fact is that the main driver of inequality is not from changing pay scales within firms, but changing pay scales between firms. In other words, superstar firms that are torching the competition with higher productivity are paying all of their workers better, and Cowen believes this rise of superstar firms is thanks in large part to good CEOs.

The benefits of the financial industry are not always obvious for the typical citizen but Cowen tries to paint a brighter picture. He points to the role of credit in supporting the country’s biggest projects and the strong correlation between prosperous countries and the health of their financial sectors. American venture capital, he believes, is the envy of the world and funds some of our greatest success stories – without ever expecting a bailout. The American banking system is more fragmented than any other high-income country in the world, and the proliferation of smaller banks during the Great Depression shows “breaking up the banks” is no guarantee in preventing catastrophe.

Contemporary tech companies give us unparalleled power at our fingertips, often for free. The cost of privacy has become the common public rallying cry but Cowen still believes their value to each and every one of us far exceeds the cost. We’ve become so accustomed to free email, free mapping, one-day shipping, and reliable spreadsheets that it’s easy to only focus on what appears to be corrupting market power. But only recently did companies like Kodak, Myspace, General Motors, IBM, AOL, and Blackberry seem to be too dominant. The image of too-powerful tech titans complicates our appreciation for the value of these companies, in Cowen’s mind. The common criticism of brain-rot through the internet and smartphones is strikingly familiar to the doomsday predictions of yesteryear about the opera, rock and roll, and the novel.

The election of Donald Trump shows the hold of big business on government is not nearly as strong as portrayed, Cowen believes. Business leaders most often state their priorities to be predictability, more open immigration, and free trade – a clear opposite to Trump’s policies. The $3 billion companies spend annually on lobbying is pennies compared to the $200 billion they spend on advertising. Farm subsidies – one of the most offensive instances of crony capitalism in the Federal budget – only accounts for $20 billion a year out of a $4.4 trillion budget.

In Search of a Better Alternative

But to all of the good of businesses, a skeptical outsider would rightly point out that these realities exist within the current system. What if we lie on our resumes because it’s a brutal rat race economy? Or we lie on our dating profiles because the market economy conditions us to be self-interested and cut corners to get ahead? It’s true that Monsanto supplies the food that keeps me alive, tech giants allow me to communicate with my family, and big pharmaceutical companies produce drugs that fight infections. Every prosperous society has indeed depended on a well-oiled financial system. And the dignity of work that employers give us through jobs is indeed important. But why are these actions necessarily being done in the most optimal way?

Feudal lords could be given credit for the food given to peasants or the dignity their work provides, tyrannical leaders for military protection, and the DMV for making sure our roads are safe. Skeptics of the market economy believe that we could have a world that is more prosperous, more egalitarian, and more ethical under a different regime. Just as an anarcho-capitalist would refute gratitude towards roads or a public school education with “well, the private sector could do it better,” any critique of the status quo asserts a superior alternative outside big business.

Incrementalists who criticize big business may just want more regulation or more support for small business, while radicals prefer more public ownership. I sense that many of Cowen’s observations on the goods that big business provides will fall on deaf ears to skeptics whose prior beliefs are that we could have an even better regime.

Of course, Cowen is up against an insurmountable foe in many of those skeptical arguments. Critics of the status quo can struggle to find strong counterfactuals in order to prove there is a better system out there. Saying that “culture and economy would shift under a different system to one where we’d all be moral, not run the rat race, cut corners, or tolerate pollution” is a tough argument to prove or disprove when it is so hypothetical.

In Cowen’s (wonderful) podcast, he always asks the guest about their “production function” – what habits/routines the guests do to ensure their highest productivity. In a recent Ezra Klein Show podcast episode about workism, Ezra brings up how an inevitable part of capitalism is the encouragement to always maximize productivity…even doing something like meditation or wellness as a means to counteract the toxins of modern life. But it’s still under a framework of “optimizing” time. Can this cultural reliance on “productivity” actually make us miss the point, even when we appear to be cognizant of mindfulness? For an infovore like Cowen, the current culture and system gives him every opportunity he can to learn and explore new things. But for the vast majority of us, are smart phones instead just giving us a bigger portfolio of addictive distractions from more important matters?

As a response to skeptics, Cowen points to data he believes reveals that – despite our self-reported disdain for tech and working – we love our smart phones and love working. He says that the fact Americans work longer hours now than they did in 1950 shows we necessarily like our jobs better. But what if we are just being motivated to “keep up with the Joneses” and none of the extra work is actually making us better? Similarly, he argues few people actually leaving Facebook despite all the public criticism shows that people like it a lot more than they let on. But the powerful network effects and addictive qualities of social media are not always the easiest thing to shake off. It seems a far jump to assume these facts necessarily reveal strong-willed rational decision-making. It’s not encouraging that the people who designed the notification mechanisms for phone apps don’t let their own children use them.

So Why the Hate?

The last chapter of Big Business addresses a lingering question: If big business is so good, why does everyone seem to hate it? While the vast majority of the population loathe the post-Citizens United saying that “corporations are people,” Cowen believes we indeed do anthromorphosize corporations. In fact, projecting human qualities onto our outside world is how we have long attempted to understand and relate to it. In all of recorded history, civilizations have told stories of the weather and natural forces as gods with faces, arms, and legs. “When it comes to our cars, our ships, and our pets, we give them names, talk about their loyalty, and feel abandoned or let down if they disappoint us.”

It is this humanizing fact that makes us inevitably disappointed by corporations’ performance. We want them to be our fuzzy friends that take care of us but in the end they are actually just … “faceless” corporations. It presents a case that we will never be grateful enough for what big businesses do for us. Cowen says hating corporations is like hating your parents – the people who give you everything but also enforce rules. This might be true…but again, couldn’t oppressive feudal landlords fit the same description?

 

It’s important to view any analysis of big business in “net net” terms by focusing not only on the most outrageous failures, but the tremendous good big business brings to our lives. To these points, Cowen does a service by providing under-appreciated defenses of the most common shortcomings of big business. I agree with Cowen’s point of view and think big business needs more appreciation. In the end, skeptics may be impossible to sway as they rely on non-falsifiable hypotheticals. But a better appeal to their stronger arguments would likely leave a stronger impression on the critics of big business.

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Is there an Equilibrium for a Free-Market Welfare State?

Sam Hammond of the Niskanen Center wrote an excellent piece analyzing the under-appreciated complementarity of a strong social safety net and free market policies. Separating labor market and business regulation from social spending, Hammond goes on to argue that there is a steady equilibrium correlation between how free a country’s economy is and how generous their social safety net is. While I applaud his line of thinking on how free market policies and social insurance can be mutually reinforcing, I am not as convinced that there is necessarily a strong equilibrium relationship between the two, nor that the US is in an unsteady state that could lead it down the road to further reactionary populism.

Why the Market Economy Benefits from a Strong Safety Net

As an economy grows and adapts to changing demands, Joseph Schumpeter observed, a process of “creative destruction” leaves newly obsolete industries and skills in the dust. The displaced workers from this process can be enticed by populist revolts that threaten to counteract the productive forces of a market economy. Hammond’s paper “argues that the countries that have eluded Schumpeter’s dreary prediction have done so by combining free-markets with robust systems of universal social insurance.” In other words, if any polity wants to enjoy the fruits of a well-functioning market economy, it needs to cushion the blow for those that are harmed by the inherent dynamism that allows it to prosper. With its relatively stingy cash benefits, the United States is at risk of sliding into a policy environment that removes its unique dynamism.

Hammond argues a more generous social safety net can complement, rather than work against, the power of markets by, among other things: 1) promoting entrepreneurial risk-taking by spreading out risk across society; 2) address the painful adjustment costs embedded in a dynamic globalized market economy; 3) replace policies that ostensibly increase economic security but inevitably decrease economic flexibility; 4) increase labor market flexibility by detaching “important social benefits…from any particular employer or market structure.”

The False Dichotomy of Economic Policy-making

Many tend to incorrectly see economic policy regimes as necessarily being a bundled package. One political party may favor stronger unionization, have a more interventionist approach to industry, a more progressive taxation scheme, and a more generous welfare state, while the other wants to decrease the power of unions, privatize more government functions, lower top marginal tax rates, and cut social spending. In reality, it’s not one bundle or the other. It’s possible to have a generous social insurance system as well as a lightly-regulated economy. Hammond makes a distinction between a Swedish “social insurance state” that has generous social insurance policies but a relatively unregulated marketplace, with a Venezuelan “interventionist state” that relies on nationalization and inflexible labor markets. Both can be referred to as “socialist” or “social democratic” in political discourse, but of course their policy combinations are far from identical. The ideal scheme, according to Hammond (and one I agree with), is one that combines the powers of the market economy with a generous welfare state.

[As a slight aside, this overall point is something I want to increasingly shout from the rooftops. Opponents of “capitalism” or market economies tend to associate pro-market reforms with skimpy welfare states, neoconservative foreign policy, and low environmental regulation. The Niskanen Center is great at producing work that combines ideal policies outside this false dichotomy.]

What Economic Freedom Should Really Mean

Often times, country rankings of “economic freedom” from the Heritage Foundation or Fraser Institute imply a necessary bundling of economic policy decisions. Both of these foundations, Hammond notes, value economic freedoms related to economic regulation, but they also value low government spending and skimpy social safety nets. To better get to an analysis showing the kind of government presence he’s talking about, he develops an index that separates social expenditures and pro-market institutions from “government size.” The economic freedom index thus values government transparency, rule of law, and regulatory efficiency while the social welfare index suggests higher income transfers. Economic freedom does not need to mean low taxation and social spending. We’re left with this graphic:

The graphic suggests a correlation between his measure of economic freedom and income security. But instead of just saying this is a correlation, he believes the relationship is in fact an equilibrium, and countries that diverge from the path by becoming either economically less-free or decrease welfare spending are at risk of falling down the path to populism found in the bottom left quadrant. In theory, these countries are in disequilibrium, as I see it, because an economically less-free country with generous welfare spending would have low-growth that couldn’t support its welfare state. Meanwhile, an economically free country with skimpy benefits wouldn’t be able to cushion the blow from an ever-changing economy.

But is there a Steady-state Equilibrium?

This is where I’m skeptical. The United States is a significant outlier here. An atypical amount of our government spending goes towards military ventures, but I don’t think that collapsing military spending would result in a more generous welfare state. I’m drawn to this Glaser et al paper suggesting that skimpier US welfare state spending comes from historical and cultural realities that are hard to undo by overnight Federal policymaking. Specifically, the paper suggests that “racial fragmentation is a powerful predictor of redistribution” across countries, and America’s cultural/racial heterogeneity could lead to an unwillingness to provide strong social welfare benefits that is difficult to overcome. The United States is atypical in many regards to other OECD countries, and a big difference is this diversity. Scandinavian countries with relatively homogenous populations could be seen as more willing to provide a social safety net because people perceive their tax dollars as going to people just like them. Countries like Italy or Spain, with relatively less national unity than Denmark or Norway, have administratively weaker welfare states.

Although Nordic countries have recently experienced a surge in “otherness” migration – and with significant frictions politically as they try to protect their natives and welfare states – it’s not clear to me that the dust will settle with these countries having their generous welfare states remain in place. I don’t mean to argue against diversity or say it can’t coexist with strong social spending; instead, I want to assert the common tension between the two and point out that America’s atypical cultural heterogeneity could be an endogenous force working against political willingness to increase social spending. Further, as Hammond notes, Sweden was in an equilibrium in the 70s and 80s more in line with the bottom left quadrant of his graphic than the top right. A particularly bad recession in the early 90s shocked the country and resulted in liberalization of markets but preserved strong social insurance programs. But if Sweden can suddenly switch quadrants, what makes Hammond so sure it can’t just as easily switch back?

A further argument against the inevitability of this equilibrium is in the United States’s long history. Sure, countries in the Anglo world are today on a more authoritarian path with Trump/Brexit than many other OECD countries, likely stemming from an inability to protect citizens who were displaced by globalization. But the United States has never had a particularly strong welfare state? The “pull yourself up by your bootstraps” mentality is a part of what is deemed American exceptionalism. The United States transitioned from an agricultural country to industrial without falling out of this bottom right quadrant. The transition didn’t come without side effects – agricultural subsidies today can be seen as a historical concession towards farmers harmed by the change – but the United States still never left its unique quadrant. Now, maybe I’m oversimplifying United States economic history here, or not involving the nuances of European economic history either. But if I really am misunderstanding history, it begs the question of whether Hammond can show that his graphic is robust enough throughout time in order to prove that this is indeed an equilibrium.

To say that a more robust welfare state counteracts the forces that led to Trump and Brexit also seems like a stretch to me. Specifically, Hammond believes that a well designed welfare state could alleviate “search and adjustment costs…with a system of subsidized employment for the long-term unemployed, combined with job search and relocation supports for geographically locked workers.” I’m skeptical the proverbial rust-belt Trump voter that used to thrive in a coal-fueled world or manufacturing-based American economy will be helped much by this. These workers have a strong connection to the identity their job provides them. I don’t just mean the purpose or community employment gives them. A coal miner isn’t suddenly going to become a male nurse just because that’s where the economy is producing jobs, no matter how much assistance the government gives them. The assembly line worker in West Virginia isn’t going to start to learn Python and move to Silicon Valley. The fact of the matter, as I see it, is that the economic displacement from globalization and automation interacts with a stubbornness of human nature that leaves many workers potentially unable or unwilling to participate in the new economy, regardless of government support. [I’d note that this job-identity relationship extends to professional-class workers who probably refused to work retail jobs during the Great Recession. Our employment opportunities are tied to how we see ourselves, and I think government spending can only do so much here.]

Hammond writes that “unregulated open economies are vulnerable to reactionary populist backlashes when the forces of creative destruction leave large swaths of society behind.” But take a look at his graphic showing OECD countries and their level of “cash minimum-income benefits.”

Greece paints a picture of an unstable populist backlash, but what about other countries on the left-side of this distribution? Is Canada unstable? South Korea? Hong Kong and Singapore are atypical city-states, but I don’t see them as being at risk of going in a more authoritarian direction, either. Perhaps it’s possible for countries to exist as free-market states without having pressures to increase its social welfare spending. History, culture, demographics, or even size/government setup – something particularly unique about the United States – could lead countries to a steady-state outside the correlation Hammond’s graphic suggests. And if there is no equilibrium, can we really think of these as being necessarily reinforcing rather than just a correlation?

How to Improve American Social Insurance

Outside any theoretical equilibrium, I would like to see the policies Hammond argues for. While I may not be convinced the United States must do this in order to avoid becoming more of an authoritative populist country, I still believe a stronger safety net can complement the wonders of the market economy discusses previously. So how can the United States transition into more a top-right quadrant country? Hammond argues that social insurance schemes can be more politically viable and successful if they are designed to be “neutral” and “universal.” It’s important to be neutral – in the sense that as little as possible is left up to the discretion of policymakers that will likely pander to special interests – to avoid favoritism and cronyism. It’s important to be “universal” because programs perceived to be designated only for the poor are typically poorly-run and underfunded. Making social insurance schemes something that everyone benefits from and pays into will ensure more forces that lead to beauracratic quality and efficiency. Federalism and American attitudes could make this a relatively difficult process, but still one worth pursuing.

 

The Captured Economy

New podcast episode with Brink Lindsey and Steven Teles about their new book The Captured Economy:

Brink Lindsey and Steven Teles argue in their new book “The Captured Economy” that the last few decades have been characterized by an increase in political rent-seeking. Focusing on the financial sector, intellectual property laws, occupational licensure, and land use, they show how legislation has been captured by special interests in ways that slow growth and increase inequality. In this episode, Lindsey and Teles discuss how these policies distort various markets and cause upward redistribution, as well as the different ways we can work to better “rent-proof” our politics.

 

The Questionable Importance of Bike Helmets

At the Oxford Practical Ethics blog, Matt Baum objects to cities that have bike rental programs but don’t provide helmets to riders. His conclusion:

I applaud these city-transport schemes for being innovatively convenient and environmentally friendly. But the city, if it is going to provide such a scheme, has a responsibility to make it possible to (and indeed encourage people to) use it safely. In this case, the city has a responsibility to provide helmets.

To be sure, there’s a tension here between public health officials’ campaigns to increase rates of helmet use and local governments renting bikes to people without providing helmets. But I don’t think this is ethically such a big deal, because there’s a lot of evidence that bike helmets don’t do much to make bike riding safer.

Western Australia enacted a mandatory bike helmet law in 1992, causing helmet use rates to rise from 37% to 82%. Here’s a graph with the results:

Head injuries didn’t obviously decrease all that much, while upper limb fractures rose a lot. Risk compensation could explain why increased helmet use may not have the beneficial effect that its proponents hoped for: people who wear helmets feel safer and thus are less careful when they are riding.

Here is a study reporting results that “are consistent with the notion that those who use helmets routinely perceive reduced risk when wearing a helmet, and compensate by cycling faster.” This study found that automobile drivers are less careful around helmet-wearing cyclists than they are around bare-headed cyclists.

There are other studies that showing that helmet use does decrease head injuries (here is one), but based on my cursory examination of the literature, it doesn’t seem like there’s good enough evidence that bike helmets make cyclists safer to justify legislation mandating them. And the evidence definitely is sufficiently inconclusive to exonerate governments of cities with non-helmet providing bike share programs from any moral culpability.

 

Yglesias on Regulation

In addition to the post arguing against the mandatory licensing of barbers that W. Jerome highlighted last week, Matt Yglesias has gone on something of a liberaltarian rampage recently (see here, here, here, and here).  He’s taken some flack from his commenters for it.  His response:

A colleague mentioned to me the other day that I’m “pretty conservative” on some state and local government issues, with reference to some recent posts on occupational licensing…. I’m not. And I think that whole framing represents a bad way of understanding the whole situation.

I think it’s pretty clear that, as a historical matter of fact, the main thing “the state” has been used to do is to help the wealthy and powerful further enrich and entrench themselves…. The “left-wing” position is to be against this stuff—to be on the side of the people and against the forces of privilege… dismantling efforts to use the state to help the privileged has always been on the agenda. Don’t think to yourself “we need to regulate carbon emissions therefore regulation is good therefore regulation of barbers is good.” Think to yourself “we can’t let the privileged trample all over everyone, therefore we need to regulate carbon emissions and we need to break the dentists’ cartel.”

Our ideologies tend to encourage overly simplistic thinking on these issues.  Liberals make arguments about the existence of market failures to justify a pro-regulation stance, and conservatives/libertarians make arguments about the efficacy of free markets or the unavoidable ham-handedness of government intervention to justify an anti-regulation stance.  This ideological division makes it so that if a conservative allows that, in a given circumstance, regulation may be justified, it seems like she’s conceding something to the liberal, and vice-versa.  This makes people become increasingly entrenched in their ideological priors so that analysis of real-world issues involves little more than post-hoc justification of a forgone conclusion.

It’s too bad that political discourse is so often conducted in this way.  The world is complex; sometimes regulation is justified, and sometimes it isn’t.  It’s nice to see somebody like Yglesias who is a sophisticated enough thinker to recognize this and move beyond the one-size-fits-all arguments that are favored by his political tribe.

 

Doctors are Welfare Queens

I meant to respond to this a while ago, but a bunch of things came up, so I’m just now getting around to it.  But anyway, here goes.  In W. Jerome’s post on reducing health care costs, commenter Joe said,

We should stop requiring that people get drivers licenses to be able to drive. The government costs in running DMV’s and driver education programs are completely unnecessary. Driving accidents continue to occur even though so called “licenses” are issued every day.

I’m kidding. I’m just pointing out that you are completely neglecting the concept of safety standards in the name of capitalism and competition. The point is that standards and licensing procedures must be constantly reformed and changed as new problems arise, but never completely done away with. It seems that system you propose would result in a class based system of doctors where the rich get “gold star” doctors and the poor get doctors that by today’s standards would be completely illegitimate.

I realize you probably have a good point to make here, but you must understand the ridiculousness of the idea of a medical free for all.

First of all, comparing drivers licenses to medical licenses just doesn’t make sense. When you drive, you have very little control over whom you are sharing the road with. Having a lot of people driving around without the basic driving skills you need to get a drivers license would make driving more dangerous for everybody. It’s completely different for doctors. If there’s a bad doctor, anybody can choose not to go to her. When we drive, we can’t choose whether or not to interact with inept drivers; when we shop for medical services, we can choose to avoid inept doctors. Now, this doesn’t show that medical licenses don’t make sense and drivers licenses do. It just shows that, in certain respects, medical licenses need to be justified on different grounds than drivers licenses.

As W. Jerome said in his post, I tend to be skeptical of medical licensing. The state-enforced monopoly on medical certification creates artificial scarcity in the medical profession and prohibits a lot of voluntary transactions. Doctors have to go through an enormous amount of training to get their MDs: undergraduate pre-med courses, four years of medical school, residency. Buying services from anybody with this much training is enormously costly. And for many complicated medical procedures, this makes sense. Your really do need tons of training to perform brain surgeries. But for many tasks that doctors commonly perform, this amount of training seems unnecessary. Do you really need eight years of undergrad and graduate training to prescribe drugs, set broken bones, and diagnose basic illnesses? But the American Medical Association actively tries to limit the ability of non-MDs, such as nurse practitioners, to do these things. This results in higher health care costs and huge rents for doctors.

But how would you know the difference between good and bad medical care providers under a health care system without licensing?  Well, for one, the internet makes it much easier to get information about things like this.  Right now, I can go to Google Maps, search for restaurants and other businesses, and find user generated reviews.  There’s no reason why this couldn’t exist for medical care.  I think one reason that it currently doesn’t is that our state-enforced medical licensing system creates a false sense of security among health care consumers.  The fact that the government guarantees the quality of licensed doctors makes it so that the consumer doesn’t have to worry about it as much (although consumers probably still should worry, because we have plenty bad doctors providing care despite the government guarantee).  Having a strong consumer feedback system would give medical care providers a strong incentive to give high quality service.  All that said, there probably is still a place for government regulation of medical care provision, but I think that we would be better off if we moved to a system with lower entry barriers where a body other than the AMA determines licensing standards.

 

Public Option

An Upset Patterns reader writes in:

In all your politicalness, I don’t hear you talking much about healthcare.

True.

A cookie-cutter libertarian answer to the problem of soaring cost in health care is similar to any issue: deregulate the industry, stop giving away goodies like medicare and medicaid, and don’t give tax-breaks to company-provided health care. All of these things distort the spontaneous order of the market for health care. Regulations drive up costs more than they benefit consumers. Freebies like medicare and medicaid mean that when people are buying healthcare, they aren’t using their own money, which means they’re more likely to buy more than they otherwise would. Tax-breaks to company-provided health care mean that companies are less responsible in buying the insurance, self-employed people are crowded out, etc.

All of this make sense to me. If one is to look at a graph showing the rising cost of health care over time, there are two major “blips” in the general trend: new tax policy related to employer-provided health care after world war II and the introduction of medicare. America, by having government currently spending 50 cents of every healthcare dollar, seems to have a tragic mix of socialized and capitalist medicine.

But maybe the “get the government out” answer is too simple. Do adverse selection problems in insurance mean that making everyone buy health insurance – even those who do not need it or want it – will lower costs and expand affordability? Is there a moral concern to provide health insurance to everyone, regardless of its effect on increasing the deficit? Are insurance companies actually – as people seem to believe – screwing people out of coverage?

Obama’s proposed “public option” is a relevant issue worth discussing. What needs to be considered:

• Is this actually not going to raise the deficit? What makes it a public option if it’s not subsidized?
• Obama himself said that “UPS and FedEx are doing just fine. It’s the Post Office that’s always having problems.” Why will a government-run system be more efficient than private ones?
• This is a huge liability for the future. Programs like this one don’t go away. If costs of it get out of control in the future, as has happened with social security and medicare, it’ll be a gigantic strain on the budget.
• The number of uninsured Americans is commonly said to be about 45 million. Well, of that number, a third make over $75,000. Those are people that could afford it but don’t buy it. Is making them be covered when they choose not to be really a good answer?
• What about for people who decide, since they will get free health care no matter what, that they will start smoking, become obese, and become a crack addict? Should healthy people pay for them?

A last thought from The New Atlantic:

I’m a Democrat, and have long been concerned about America’s lack of a health safety net. But based on my own work experience, I also believe that unless we fix the problems at the foundation of our health system—largely problems of incentives—our reforms won’t do much good, and may do harm.