Tuesday, October 17, 2017

It's Time to Deregulate Adult Autism Care


The Centers for Disease Control and Prevention has been tracking the prevalence of autism spectrum disorder (ASD) since 2000. As the following chart shows, the identified prevalence of ASD among American children especially boys has been rising steadily. No one seems to know how much of the increase is due to greater prevalence of the disorder itself, or greater awareness and better diagnosis. It probably is a little of both. In any case, the number of people who were diagnosed with ASD in childhood and who now are entering adulthood is rising and will continue to increase.


Unfortunately, too many of those now entering adulthood with ASD are running into regulatory barriers that prevent them from getting the kind of care they need. This post explains the nature of those barriers and outlines changes that would help ensure appropriate care for all adults with ASD. 

Origins: Deinstitutionalization

The widespread deinstitutionalization of people with mental illnesses has been one of the most dramatic changes in social policy in the United States since World War II. According to  Dominic Sisti, Ph.D., an assistant professor of medical ethics and human policy at the University of Pennsylvania, the number of patients in state psychiatric facilities decreased from 560,000 in 1955 to just 45,000 in 2014, a 95 percent decrease in the per-capita institutionalization rate. (The linked article by Sisti and colleagues is behind a paywall, but a summary is available here.)

The deinstitutionalization movement was driven, in part, by new therapies that could be delivered outside an institutional setting and also by well-publicized abuse in mental institutions. There is no doubt that many people benefited, but for others, deinstitutionalization brought unintended consequences. For some, it resulted in “transinstitutionalization” to prisons, homeless shelters, and emergency rooms. For others, it has meant living on the street.

Friday, October 13, 2017

Help Save SlideShare! Bring Back Reupload

SideShare, the popular slideshow hosting service, has 38 million registered users and gets 70 million unique visitors a month. If you are one of those users or visitors, you can help save SlideShare from itself by bringing back REUPLOAD, an essential feature that has recently been removed.

What is Reupload and Why is It So Important?

Reupload is (or was) a feature that allowed users to repost a revised version of a slideshow without changing its URL. Now that it is gone, the only way to revise a slideshow is to delete the original version and repost a new version with an new URL. Why does that matter?
  1. Short-term error correction: We are all human. (Well, at least I am). We make mistakes. After you have posted your slideshow, you, or one of your readers, notices a typo, a wrong number in a calculation, or a broken link. You want to fix it, but meanwhile, you or your readers have bookmarked the original version, or Tweeted the link, or posted it on Facebook. When anyone follows those links or bookmarks, they will be taken to the original version with the error, not your corrected version. If you deleted the original when you made the correction, they won't find anything.
  2. Long-term revisions: Sometimes I publish a slideshow on a topic of lasting interest, say, the economics of a soda tax. I posted this version of my soda tax slideshow in 2010. Last year, soda taxes were back in the news, so I posted this revised version. At the same time, I added the little yellow box on the front page of the original so that anyone who had the old link could find the new version. This week, I wanted to update it again to include the news of the failure of Chicago's soda tax, but with reupload gone, I can no longer steer anyone who finds one of the old versions to the newest version.
  3. Classroom use: College professors and high school teachers use slideshows in their classrooms all the time. They include links to the slideshows in the printed or on-line curriculum materials they give to their students. What if the creator of the slideshow fixes an error or makes an update? Doesn't the teacher want them to find the latest version, not the old one? Without reupload, this won't happen.
What you can do

When I first contacted SlideShare about reupload, I got this non-responsive response:
Hi Ed,
Thank you for your email and I am sorry for any inconvenience this may have caused. We're always looking for ways to improve the SlideShare experience for our members. This sometimes means removing features that aren’t heavily used to invest in others that offer greater value.  Please know we continuously evaluate how features and products are used, and make adjustments accordingly to focus our resources on providing the most value to our members. As a result, we have removed the ability to re-upload documents to SlideShare.
As a workaround, you can upload a new file to SlideShare and delete the current one. Please be aware that this means we will not be able to transfer any views/likes/URL's to the new presentation.   Again, I apologize for the inconvenience and we greatly appreciate your feedback. We have documented the issue in order to track additional reports of the problem and for consideration to be addressed in a future release.
If there's anything else I can help you with, please don't hesitate to let me know. All the best,
Allison LCS Support Specialist - Mobile
This was a boilerplate response that other users have also gotten. It has been posted and reposted several times on discussion boards. I reopened the case and pointed out to "Allison" that it is nonsense. Reupload is not a feature that is "not heavily used." It is an essential feature that people use all the time. It offers great value.

"Allison" sent back this new reply that gave me a tiny bit of hope:

Thanks for your feedback about removing the re-upload feature and I wish I was personally able to do something myself however, please know I've sent your concern to our product team for consideration. Taking member feedback into account, we're always looking for ways to improve the SlideShare experience. When many of our members ask for the same improvement, we try our best to get it done. Though immediate action may not be possible, your feedback will be incorporated into our ongoing discussions about the direction of our design and development.
 
Again I apologize for any inconvenience this may have caused. If you need anything else, please let me know and I will gladly assist. 
So, if one of us complains, nothing happens, but if a lot of us complain, something might happen. Let's see if "Allison" is right. Let's send lots of requests to bring back reupload and see if they bring it back.

How to send a request to bring back reupload

SlideShare makes it pretty easy to ask for help. Here is how you do it:
  1.  Go to the SlideShare home page: https://www.slideshare.net/
  2. Scroll down to the very bottom and click on "Support" 
  3. Type "Reupload" in the search box at the top of the main support page
  4. Next, you will get a page that says, "Sorry, we couldn't find any information about 'Reupload' (unless, by the time you do this, they have added some information).
  5. Go to the bottom of that page and click on the "Contact us" link
  6. That will take you to a page where you can send a message to SlideShare help. Ask them to bring back reupload, and tell them why you care.
Thanks! If we all work together, we can save SlideShare from self-destruction!





Who are the Biggest Obamacare Losers?

In a post on Kaiser Health News, Julie Rovner discusses the plight of a forgotten slice of the population who are the biggest losers from the ACA. These are people who buy insurance in the individual market but earn too much to qualify for premium subsidies.

And no, these are not all millionaire lawyers in private practice and billionaire day-traders who work from laptops in their beach-side condos. The upper income limit for ACA subsidies is 400 percent of the poverty line, which comes to just $64,000 for a family of two. That hits ordinary working couples who would like to take early retirement, people working part-time who have outside income, and self-employed professionals. Even Uber drivers can make $64,000 a year if they work hard enough.

Rovner’s post highlights the case of a married couple from Raleigh, N.C., both in their late 50s, who work as private consultants to the energy industry. When their premiums reached $1,600 a month, with $7,500 deductible for each of them, they decided to forego insurance altogether.

Rovner calculates that there are about 7.5 million such people. That is less than 3 percent of the population, but they constitute 43 percent of those who buy insurance in the individual market.

These same 43 million who are the big losers from the ACA would be among the big winners from Universal Catastrophic Coverage. UCC, as I have explained elsewhere, has potential appeal to both conservatives and liberals. As premiums rise ever higher for unsubsidized shoppers in the individual market, the constituency for UCC can only grow.

Reposted from NiskanenCenter.com

Wednesday, September 20, 2017

National Flood Insurance: Yet Another Program in Need of Market-Based Reform




Looking for yet another costly federal program in need of market-based reform? Put the National Flood Insurance Program (NFIP) near the top of your list. It is a mess, and time is running out to fix it. As sea levels rise and extreme weather events trigger inland flooding, NFIP offers property owners insurance against flood damage at rates that do not come close to reflecting the true risk of losses. It compounds the problem by insisting that money it pays out in claims can be used only to rebuild in the same flood-prone locations—not for moving to higher ground.

There are lots of ideas for a makeover of NFIP. One obvious one would be to charge property owners full risk-based premiums. However, owners resist that measure because it would crash the value of their properties. Another reform would let owners use claims to rebuild in other, safer, areas. However, local governments where the flood-prone properties are located resist that idea because they would lose part of their tax base. Still another idea is to buy out whole communities at fair, pre-flood prices and rebuild them elsewhere. However, powerful realtor and builder lobbies resist all these reforms.

Congressional committees have been working on promising fixes. Reform proposals have been worked up to the point of being ready for a vote. But—did I mention?—Congress has less than two weeks to do something. NFIP expires at the end of September. The pressure to reauthorize it without substantive changes will be overwhelming. 

Here is some background reading if you want to pursue the cause of building a market-based National Flood Insurance Program:

  • SmarterSafer.org is a coalition that promotes risk-based insurance and risk mitigation efforts. Its website is a trove of information and links.
  • The National Resources Defense Council has a great, short backgrounder on the need for flood insurance reform.
  • An excellent article in The Atlantic by Michelle Cottle outlines the politics of flood insurance reform.
 Reposted from NiskanenCenter.org
  •  

If you Like Sanders' Healthcare Plan, Please Stop Calling it “Single Payer”




The latest version of Bernie Sanders’ Medicare for All plan (MFA) has a lot to like. Sanders is right, America needs a healthcare system more like those of other wealthy countries. But, if you like Medicare for all, please stop calling it “single payer.” The single-payer label distracts attention from the main goal of healthcare reform, it energizes the opposition, and it is not an accurate description of the Sanders plan.

The goal is universal access

Single-payer is not the goal of healthcare reform. The goal is universal access to health care. No, not “access” in the sense some Republicans use it, that is, as the opportunity to buy into the system if you can afford it. True universal access would mean a system in which anyone who needs health care can go to the doctor’s office, the hospital, or the pharmacy and get what they need with the certainty that they can afford it, no matter how modest their means.

Single-payer is better understood as one way of getting to the goal of universal access. Under a true single-payer system, when you went to get care of any kind, you would just show your healthcare ID card and the government would directly reimburse the provider in full. That would be nice. The problem is, no such system exists anywhere. Not even in the universal access systems we admire most—Sweden, the UK, New Zealand, or whichever is your favorite. In all of those countries, the government pays some of the healthcare bills and private sources pay some. As the chart shows, the government contribution is greater than it is in the United States almost everywhere, but it is not 100 percent anywhere.


Wednesday, September 6, 2017

Can Angola's New President Overcome the Curse of Riches?


The people of Angola did something recently that they had not done for a long time: They elected a new president. The winning candidate, João Lourenço, will take over from President José Eduardo dos Santos, who came into office in 1979. Lourenço, who is from the same party as dos Santos, the People’s Movement for the Liberation of Angola, received two thirds of the vote. That result is expected to stand, despite doubts about the count voiced by his opponents.

During the first two decades of dos Santos’ rule, Angola struggled with a deadly, on-again, off-again civil war. After the MPLA prevailed in 2002, Angola embarked on a peace-and-oil expansion, with GDP growing by an astonishing 22 percent in 2007 alone. The global financial crisis brought the Angolan economy back to earth, however. The following chart, from the latest FocusEconomics Consensus Forecast for Sub-Saharan Africa, details the slowdown. Not only has the growth of GDP slowed, but so have analysts’ estimates of future growth. Low oil prices, and the expectation that they will remain low for the foreseeable future, are a major factor behind the growth pessimism.

Thursday, August 24, 2017

Building Bipartisan Healthcare Reform with Conservative Bricks



Republicans now control both chambers of Congress and the White House, yet they have been unable, on their own, to fulfill their pledge to repeal and replace the Affordable Care Act (ACA or “Obamacare.”) The Democratic leadership, for the time being, seems content to watch Republican failures from the sidelines. Meanwhile, however, rank and file voters from both parties are becoming impatient. A Morning Consult/Politico poll taken in March found that 72 percent of Democratic voters, 71 percent of Independents, and 75 percent of Republicans thought the parties should work together more on healthcare reform. 

Just what kind of healthcare program might draw enough bipartisan support to pass both houses of Congress? No ACA replacement could draw significant Democratic support unless it clearly moved closer to the goal of universal, affordable health care, not away from it. At the same time, since Republicans control the committees and leadership in the House and Senate, any reform would have to start with ideas that have an acceptable conservative pedigree. 

The practical question, then, is whether it is possible to build bipartisan healthcare reform from conservative bricks. Here are three conservative ideas that might do the job.

Sunday, August 20, 2017

Little-Watched Non-Employment Index Confirms Strength of Job Market Recovery




As the Fed hesitates over the pace of further monetary tightening, some critics say that standard unemployment data from the Bureau of Labor Statistics (BLS) overstate the strength of the recovery. By focusing on the number of employed as a percentage of the labor force, the critics say, the BLS ignores those who have dropped out of the labor force altogether. However, a little-watched indicator from the Richmond Fed, the Non-Employment Index (NEI), suggests that the critics are wrong.

The labor force, which forms the denominator of the standard unemployment rate (also known as U-3), consists of all persons who are working or have actively looked for work in the preceding month. People who want a job, but have stopped working, are omitted from both the numerator and denominator. In a typical month, there are millions of such labor force dropouts, even though they are not reflected in the standard statistics.

In an effort to take at least some of those labor-force drop-outs into account, the BLS publishes a supplementary index known as U-5, which includes discouraged and marginally attached workers in both its numerator and denominator. These groups include all those who want a job and have looked for one within the past year, but not within the past month. Discouraged workers cite their belief that there are no jobs to be found as their reason for not looking for work. Marginally attached workers give other reasons, such as family responsibilities. People who say they want a job but have gone longer than a year without looking for one are not counted in either U-3 or U-5.

Tuesday, August 1, 2017

Universal Catastrophic Coverage Would Make an Excellent Centerpiece for the Next Round of Healthcare Reform


Republican attempts to reform the U.S. healthcare system have fallen short, yet again. Sen. John McCain, who cast the deciding vote against the last-ditch version of repeal-and-replace put forward by the Senate leadership, told his colleagues,
We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of the aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people. We must do the hard work our citizens expect of us and deserve.”
More tinkering won’t do it. It is time to get serious about keeping the promises GOP leaders made at the very outset of the debate over healthcare reform—not just to repeal Obamacare, but to replace it with something that provides “coverage protections and peace of mind for all Americans—regardless of age, income, medical conditions, or circumstances,” while ensuring “more choices, lower costs, and greater control over your health care.” There is no point in making a new push for healthcare reform without putting some bold new ideas on the table. 

Universal catastrophic coverage (UCC) would make an excellent centerpiece for the next round of healthcare reform. In fact, UCC is not even particularly new to the conservative playbook. Respected thinkers like Martin Feldstein, who would go on to serve as Ronald Reagan’s chief economic adviser, promoted the idea already in the 1970s. In 2004, Milton Friedman, then a fellow at the Hoover Institution, also endorsed the concept. UCC would make healthcare affordable, both for the federal budget and for American families. And because it would throw no one off the healthcare roles—not 22 million people, not 2 million, not anyone—it offers a realistic chance of the bipartisanship that polls show both the Republican and Democratic rank and file want.

Thursday, July 20, 2017

Climate Change Will (Probably) Not Destroy the Global Economy but That Doesn't Mean We are Out of the Woods

Climate change is on course to do a lot of harm to our planet. That is why concerned economists like myself advocate measures that would at least slow the pace of damage and give us more time to adapt. Paradoxically, though, economists rarely discuss what global warming is likely to do to the economy itself. Will climate change destroy the global economy as it raises sea levels, intensifies extreme weather, and kills our crops? The answer turns out to be more complex than you might think.

It is certainly not as simple as David Wallace-Wells endeavors to make it in his widely read New York Magazine article. In it, Wells describes an uninhabitable earth and a devastated global economy by the end of the century. Here is how he explains the economic consequences of climate change:
The most exciting research on the economics of warming has also come from [Solomon] Hsiang and his colleagues, who are not historians of fossil capitalism but who offer some very bleak analysis of their own: Every degree Celsius of warming costs, on average, 1.2 percent of GDP (an enormous number, considering we count growth in the low single digits as “strong”). This is the sterling work in the field, and their median projection is for a 23 percent loss in per capita earning globally by the end of this century (resulting from changes in agriculture, crime, storms, energy, mortality, and labor.)

Tracing the shape of the probability curve is even scarier: There is a 12 percent chance that climate change will reduce global output by more than 50 percent by 2100, they say, and a 51 percent chance that it lowers per capita GDP by 20 percent or more by then, unless emissions decline. By comparison, the Great Recession lowered global GDP by about 6 percent, in a one-time shock; Hsiang and his colleagues estimate a one-in-eight chance of an ongoing and irreversible effect by the end of the century that is eight times worse.

The scale of that economic devastation is hard to comprehend, but you can start by imagining what the world would look like today with an economy half as big, which would produce only half as much value, generating only half as much to offer the workers of the world.
The problem, however, is that the paper to which Wallace-Wells refers says nothing of the sort. The paper was written by Marshall Burke, Solomon Hsiang, and Edward Miguel, and published in Nature in 2015. The authors do not say that climate change will make the world economy of the future smaller than it is now, but rather, smaller than it would be without climate change. Here is a quote:
[U]nmitigated warming is expected to reshape the global economy by reducing average global incomes roughly 23% by 2100 and widening global income inequality, relative to scenarios without climate change. [Emphasis added.]

Friday, July 14, 2017

Latest Senate Healthcare Bill is a Step Toward Universal Coverage but Not Bold Enough

 Universal health care access is coming to America. As I wrote a few weeks ago, it is time to stop fighting it and make it work. In principle, Republicans agree. After all, from the very start of the repeal-and-replace debate, they have explicitly promised “coverage protections and peace of mind for all Americans.”

The latest version of the Better Care Reconciliation Act (BCRA) takes new steps toward universal access, but it is not yet bold enough. If our Senators only had the courage, they could build on these ideas to craft a plan that would satisfy both conservatives and moderates in their own ranks. Furthermore, it could become a way for the GOP to work together with Democrats, which polls say is what the public wants.  Here is how it could be done.

Thursday, July 13, 2017

How Conservatives Could Design a Fair and Efficient Healthcare System if they Took their Time



Senate Republicans fell short in their first attempt to attract fifty votes for their healthcare bill. Small wonder. The Better Care Reconciliation Act (BCRA), as it is called, is remarkable in many ways, but perhaps remarkably of all, it fails  to draw on a large body of conservative reform proposals. As a result, it gives the false impression that only liberals have given any thought to how to design a fair and efficient healthcare system.

Now the Senate’s Republican leaders have a second chance. Instead of rushing something out that isn't much of an improvement, they could use the extra two weeks they’ve given themselves in August for open hearings on healthcare reform. If they did so, they would have a chance to hear day after day of testimony from conservative scholars and policymakers. Here are some key points that testimony would make, if it had a chance to be heard.

Some of that testimony would focus on the top end of the spending curve. As the chart below shows (based on data from the National Institute for Health Care Management Foundation), just 1 percent of the population accounts for 20 percent of all personal healthcare spending, and the top 5 percent of population for half of all spending. Many people in that range suffer from one or more chronic conditions like diabetes, kidney failure, or AIDS that require expensive treatment year after year. Their medical needs are literally uninsurable by traditional standards. They are not just at high risk of needing care, they are certain to need it. And even if an insurer could be persuaded to cover them, an actuarially fair premium would exceed the annual income of all but the very wealthiest among the 
chronically ill.

Saturday, July 8, 2017

Unintended Consequences of Healthcare Decentralization



All economic policies have unintended consequences. The decentralization of healthcare finance and policy proposed by congressional Republicans is no exception.

The Better Care Reconciliation Act (BCRA) pending in the Senate would sharply shift responsibility for healthcare toward the states. Some of the biggest changes would come in Medicaid. would sharply cut federal spending, leaving states with the choice of responding by increasing their own contributions to maintain current enrollments, or by reducing coverage. Aside from Medicaid, they would gain the right to redefine the essential services insurance must cover, to experiment with high risk pools, and to change policies toward pre-existing conditions.

A group of GOP senators skeptical of the BCRA have offered a different proposal that would permit even greater diversity in state healthcare policy. The Patient Freedom Act sponsored by Senators Susan Collins (R-ME), Bill Cassidy, MD (R-LA), Shelley Moore Capito (R-WV) and Johnny Isakson (R-GA) would give states three choices: Keep the existing framework of the ACA with most of its federal subsidies, sign up for a new market-oriented system centered on direct contributions to health savings accounts for each individual, or design a new system of their own, with federal approval.

Friday, June 16, 2017

Jobs are No Reason to Quit the Paris Climate Agreement

Donald Trump cited “jobs” no fewer than eighteen times in announcing his plans to withdraw from the Paris climate agreement. Nonsense. Jobs are not a good reason—in fact, they are no reason at all—for that decision.

Let’s start with the fact that the US economy doesn’t really need more jobs. We are already awash in jobs. At the macro level, there is no sign that the Paris accord, in place for over a year now, has hurt the steady growth of employment. Neither has it slowed the decline of unemployment, which reached a 16-year low in May. Take a look at the charts. Do you see a sharp break over the last year, since the agreement was signed? I don’t.

To be sure, the Paris agreement is not yet fully in effect, but markets are forward looking. If employers expected the agreement to put the brakes on growth, they would have been holding off on hiring already. What would be the use of taking on workers you are just going to have to lay off as soon as those onerous regulations come into play? If the charts tell us anything about Paris and the job market, it is not how great the employers expect the effects to be, but how small.

But that’s just the macroeconomic perspective. What about low rates of labor force participation and declining labor mobility? Those are real problems, but they have been around, and growing more serious, since long before the Paris agreement was even in the planning stages. Getting out of Paris will not fix them.

Wednesday, May 31, 2017

Would Hayek Have Supported a Carbon Tax? A Rejoinder to Robert Murphy



 On April 12, I posted "Hayek on Carbon Taxes: Prices Without Markets or Markets Without Prices?" both on this site and that of the Niskanen Center. On May 30, Robert P. Murphy posted a response on the Institute for Energy Research. I submitted a rejoinder as a comment, but some readers of the IER site have not been able to view it, so here is my rejoinder in full.

(1) With regard to “hijacking the legacies of deceased libertarians”: I would have thought that it would be obvious to any reader that to say, “Hayek would have supported a carbon tax,” is simply a rhetorical device that means “Hayek’s works contain arguments that bear directly on this issue.” I said that explicitly in the first sentence of my post. There is no hijacking going on here.

Monday, May 22, 2017

Economic vs. Personal Feedom in Singapore



Today’s New York Times carries an op-ed by Singaporean novelist Balli Kaur Jaswal on censorship in her home country. It begins by describing the deletion of scenes from American TV shows that feature taboo subjects like vibrators and nonbinary gender identification. It continues with a tongue-in-cheek account of her efforts, together with high-school friends, to figure out just what “sex” was by raiding their mothers’ stashes of contraband women’s magazines. But the real point of the op-ed is a serious one: In Singapore, freedom of information is spotty, at best.

The story sent me running to one of my favorite data troves: The rich collection of statistics on economic and personal freedom put out by the Cato Institute’s Freedom of the World project. Singapore is famous for its economic freedom. On the Cato economic freedom scale, it earns a score of 8.71 out of a possible 10, second only to Hong Kong’s 9.03. The high rating is helped along by sound money, free trade, and a small government, along with perfect 10s in areas like freedom to dismiss workers, freedom from minimum wage requirements, and freedom to practice your chosen profession without a license. These economic freedoms pay off in terms of prosperity. Singapore’s GDP per capita is third in the world, after Qatar and Luxembourg.

When it comes to personal freedom, though, it’s another story. On Cato’s personal freedom index, Singapore ranks seventy-seventh out of 159 countries, a little better than Cambodia or India, but not as free as Turkey or Papua New Guinea. What’s the problem?

Friday, April 21, 2017

How Big Government Affects Freedom and Prosperity


Economists, libertarian economists included, love to measure things. The Human Freedom Index (HFI) from the Cato Institute is a case in point. Its authors have assembled dozens of indicators of personal and economic freedom. They invite interested researchers to use them to explore “the complex ways in which freedom influences, and can be influenced by, political regimes, economic development, and the whole range of indicators of human well-being.”

I am happy to accept the invitation. This post, the first of a series, will take a first look at what we can learn from the data about the relationships among freedom, prosperity, and government. The relationships turn out to be not quite as simple as many libertarians might think. 

The Data

The Human Freedom Index consists of two parts. One is the Economic Freedom Index (EFI) from the Fraser Institute, which includes measures of the size of government, protection of property rights, sound money, freedom of international trade, and regulation. The other is Cato’s own Personal Freedom Index (PFI), which includes measures of rule of law, freedom of movement and assembly, personal safety and security, freedom of information, and freedom of personal relationships. The Cato and Fraser links provide detailed descriptions of the two indexes.

In order to explore the way freedom influences other aspects of human well-being, I will draw on a third data set, the Legatum Prosperity Index (LPI) from the Legatum Institute. The LPI includes data on nine “pillars” of prosperity, including the economy, business environment, governance, personal freedom, health, safety and security, education, social capital, and environmental quality.
The EFI and PFI cover 160 countries and the LPI 149 countries. In this post I will use the set of 143 countries for which data are available in all three indexes. The Cato, Fraser, and Legatum links above provide detailed methodological information.

Thursday, April 13, 2017

Hayek on Carbon Taxes: Markets without Prices or Prices without Markets?



As far as I know, Friedrich Hayek never wrote a word about climate change, but two of his most famous works contain arguments that bear directly on this key issue of environmental policy. Judging from what he wrote about the role of science in public policy and the use of knowledge in society, I think that if he had lived on into the twenty-first century, he might have supported a carbon tax.

The role of science in public policy

Hayek’s 1945 article, “The Use of Knowledge in Society,” draws a distinction between two kinds of knowledge. One is “knowledge of the particular circumstances of time and place,” that is, knowledge that is widely dispersed among individuals, each of whom sees only a small part of the whole picture. The other is scientific knowledge, which, he says, we can reasonably expect to find in the possession of a suitably chosen body of experts.

Most of the article focuses on how best to make use of dispersed knowledge. However, near the beginning, Hayek comments briefly on the role of scientific knowledge:

It may be admitted that, as far as scientific knowledge is concerned, a body of suitably chosen experts may be in the best position to command all the best knowledge available— although this is of course merely shifting the difficulty to the problem of selecting the experts.

Hayek quickly moves on to his main subject, but he returns to the issue of scientific knowledge several years later.  In a 1960 essay, “Why I am Not a Conservative,” he explains the differences between the conservative worldview and that of “liberals,” a term Hayek uses in the European sense for what Americans would call classical liberals or libertarians. Liberals, he says, are prepared to come to terms with new scientific knowledge, whether they like its immediate effects or not. Conservatives, in contrast, are more wary of science:

Monday, April 10, 2017

High-Risk Pools Pose a Dilemma for Conservatives

High-risk pools have played a prominent role in the debate over U.S. health care policy, especially on the conservative side. In contrast to liberals, who lean toward a single-payer system or public option, conservatives would like to limit the government’s role to the very sick and the very poor. For the poor, they seem ready (grudgingly) to accepted Medicaid, or something like it, as long as coverage is limited to the “truly needy.” What to do about the very sick is a more complicated problem. High-risk pools, which both HHS Secretary Tom Price and House Speaker Paul Ryan have endorsed, offer a possible solution, but one that comes with issues of its own.

High-risk pools in theory

High-risk pools are a response to the inability of private companies to offer insurance at an affordable premium unless their pool of customers has enough healthy individuals to keep average  claims low. If too many sick people join the pool, claims and premiums, begin to rise. Rising premiums cause healthy people to drop out of the pool and take their chances on life without coverage. The dropouts push premiums higher still for those who remain in the pool until, eventually, no one can afford coverage. Economists call this phenomenon adverse selection. It is popularly known as a “death spiral.”

The traditional way of dealing with adverse selection was to practice medical underwriting, which means dividing the population into separate pools according to health status. If medical underwriting is permitted, insurers quote premiums that reflect the actuarial risk of each pool. They may refuse altogether to cover people with pre-existing conditions, cover them only at very high rates, or place caps on annual or lifetime benefits.

Although it keeps premiums affordable for the relatively healthy, medical underwriting inevitably means that some people cannot obtain coverage at an affordable premium, or have exhausted their coverage by reaching their spending caps. Before the Affordable Care Act (ACA or “Obamacare”) limited medical underwriting, many states created high-risk pools to meet their needs. Such pools were not intended to be profitable and were supported by government subsidies.
Described in this way, high-risk pools sound like a good compromise between the comprehensive government health care found in the rest of the developed world, and a purely market-based system that would make health care unaffordable for any but the healthy and the wealthy. What could go wrong? Several things, it turns out.

Saturday, April 1, 2017

Universal Healthare Access is Coming to the US. Stop Fighting It. Make it Work.

Many observers are describing the dramatic failure of the American Health Care Act (AHCA) as a debacle, but perhaps it will prove to be a step forward. As everyone knows by now, the United States is alone among advanced economies in not having universal access to health care, but it is already much closer to such a system than most people realize. The defeat of the ACHA may be a tipping point in which the forces trying to figure out how to make universal access health care work gain the upper hand over those that are fighting it.

The true scope of government in our healthcare system

The term “single payer” is often used to describe the healthcare systems of other high-income countries. Although that is a convenient term, it is not entirely accurate. As the following chart of healthcare spending in OECD countries shows, all countries use a mix of private and public payments. Furthermore, even in many countries where the government share of spending is high, the actual administration of payments is split among several funds, trusts, or regional agencies. There are no countries where all health-related services, including optical and dental services, drugs, and long-term care, are entirely free to patients without co-pays or deductibles.  Healthcare systems of OECD countries also differ widely in such aspects as whether facilities are publically or privately owned, whether doctors are public employees or independent practitioners, and whether private provision of healthcare, in competition with public services, is encouraged or discouraged.

Wednesday, March 15, 2017

To Succeed, Healthcare Reform Must Include Action on Prices

 Republican reformers have repeatedly promised affordable healthcare for all Americans — doubly affordable, in fact. They promise to put premiums and out-of-pocket costs within reach of low- and middle-income consumers, and at the same time, that the plan will be affordable to the federal budget, even given the constraints their most conservative members would like to impose on federal revenues.

Unfortunately, the American Health Care Act (AHCA) now before Congress will make healthcare affordable in the budgetary sense only while making it less affordable in the individual sense. According to analysis by the Congressional Budget Office, the AHCA will reduce the budget deficit by $337 billion over a ten-year period, but only at the expense of reducing the number of insured by 14 million in the near term and by 24 million after the full effects of the bill come into force. As the CBO points out, even many people who retain coverage will find it more expensive because the ACHA tax credits will be less than the subsidies available through exchanges under the current Affordable Care Act (ACA or "Obamacare"). For others, the only option that will become more “affordable” is that of going without insurance, due to the ACHA’s elimination of the ACA’s individual mandate.

Under the ACHA or ACA, one uncomfortable fact remains unavoidable: There is no way to make healthcare affordable for either the budget or individuals without strong action to control prices for drugs, medical devices, hospitals, and doctors’ fees that are higher than in any other country. The current draft of the ACHA does nothing to deal with that critical problem.

Monday, March 13, 2017

Why California's Push for a 100 Percent Carbon Free Grid is the Wrong Way Forward


Although there is a clear lack of will to do much about climate change at the federal level, California is another story.  In a recent poll, 69 percent of California voters backed policies to cut emissions. The latest sign of enthusiasm is a bill introduced by State Senate leader Kevin De León that would completely decarbonize the state's electric grid by 2045. Currently, California state law calls for half of all retail electricity to be produced from renewable sources by 2030, with an intermediate goal of 25 percent by 2016, reached slightly ahead of schedule.

Is 100 percent decarbonization feasible? Anne C. Mulkern, writing for E&E News, reports that several experts she talked to said it was. Utility executives were somewhat more skeptical, but Pedro Pizarro, CEO of Edison International, agreed that 100 percent renewable power was technically possible, while expessing concerns about reliability, and timing.

Even if the goal is technically it possible, though, does it make sense to mandate a goal of 100 percent renewable electric power by a certain date? In my view, it does not. Carbon pricing remains a better tool for reducing California's carbon footprint.

Carbon pricing California style

But, you might say, hasn't California already tried carbon pricing with its flagship cap-and-trade scheme? Yes, and it isn't working very well. However, if we look carefully, we will see that the problems arise from circumstances particular to the state, rather than from any inherent flaw in carbon pricing as a concept.

The economic reasoning behind cap-and-trade is to give companies an incentive to reduce emissions by requiring them to buy a permit for each ton of carbon dioxide they emit. The higher the price of permits, the greater the incentive. Prices are set by monthly auctions supplemented by a secondary market, in which permits can change hands privately.