Tuesday, November 24, 2009

I liked David Brook's framing of the health care debate as "The Values Question." He sums up the dilemma succinctly:

The bottom line is that we face a brutal choice.

Reform would make us a more decent society, but also a less vibrant one. It would ease the anxiety of millions at the cost of future growth. It would heal a wound in the social fabric while piling another expensive and untouchable promise on top of the many such promises we’ve already made. America would be a less youthful, ragged and unforgiving nation, and a more middle-aged, civilized and sedate one. [emphasis added]

I agree (mostly). He makes a strong assumption concerning the disastrous level of costs and drag on the economy from a revised health care approach. That may actually be the case, or it may turn out to be overstated. However, have we not also overestimated the boost to the economy of supply-side economics, and for that matter, underestimated the drag on the economy from the disparity in income and opportunity (e.g. lost H.C.)? I wonder, since we have erred on the side of allocation for so long, might it be time to err on the side of distribution and see what that might do for the well-being, and even productivity, of the nation? Is the choice between decency and vibrancy truly a zero-sum game?


Steven McMullen said...

While it might be the case that there need not always be a trade-off between wealth(efficiency) and equality, I think Brooks is right to frame this particular debate in this light. All the CBO reports have indicated that the policies being debated will end up increasing, not decreasing health care costs, and shift the payment from individuals to government.

This will likely result in a more just outcome, but the price will be high.

Becky Haney said...

I agree that the price may be high. But, is not the cost of choosing a more "vibrant" society also high? And, the cost seems to be born primarily by the most vulnerable. It seems strange to me that we more easily perceive impacts on an abstract growth concept than on real, vulnerable human beings. If the gains from growth were reaching the most vulnerable (a rising tide lifts all boats) rather than gravitating to the already wealthy, growth as the goal might be "decent" as well as vibrant. But three decades of increases in income and wealth concentration among the already wealthy, with little or no growth for the rest doesn't support that.

Steven McMullen said...

"It seems strange to me that we more easily perceive impacts on an abstract growth concept than on real, vulnerable human beings."

I am not sure this is true. If the "we" is economists, then perhaps it is true because we are used to paying attention to efficiency, which we believe correlates with aggregate wealth (growth). But I believe the general tendency is the opposite. Most of the narratives in political rhetoric and media coverage of this debate focus solely on "real vulnerable human beings." Advocates talk about giving people access to care at reasonable prices. Those on the other side talk about the tax burden that will fall on ordinary people and the possible implications of rationing.

I don't think most people think in terms of economic growth unless "growth" is translated into "jobs." Which gets us back to "real, vulnerable human beings."

On the contrary, I think people have a difficult time thinking about the cost of these things. It is very difficult to understand intuitively that universal insurance will result in more use of medical care and a likely increase in the real cost of care(not the marginal cost to an individual). Especially since the total cost is only passed on in the form of higher taxes and fewer services of other kinds.

Jaakko said...

I certainly agree with Brooks that this question is about values. Still, I am not sure if I would frame my question quite like that - as the young against the old. I would remark that there can be a win-win situation even if interests are antagonistic:

"Disputant after disputant vainly strives to show that the interests of the masters are, or are not,
antagonistic to those of the men: none of the pleaders ever seeming to remember that it does not absolutely or always follow that the persons must he antagonistic because their interests are. If there is only a crust of bread in the house, and mother and children are starving, their interests are not the same. If the mother eats it, the children want it; if the children eat it, the mother must go hungry to her work. yet it does not necessarily follow that there will be “antagonism” between them, that they will fight for the crust, and that the mother, being strongest, will get it, and eat it."

I think that most mothers would give the bread to their children and so doing show that they prefer such line of action. And so doing grow as a human being.

It is of course different with health care because there the decisionmaker is not the mother or any other individual directly but through the government.

Would it be good that the government would force the mother to give to her child? Or in the case of health care from child to the mother?

I think in a world as it is, it would make much sense to make such regulations, that mother would need in many cases give more to her children than she does and children to their mothers, for in my opinion people are very wicked and thus need such restrictions as the health care reform. But that is because of my value judgements. Namely that the restrictions in personal freedom as a result of higher taxes do not outweigh the benefits from more distributive justice. I understand that the opinions can differ here.

But the most important task for anyone would ofcourse be to make oneself and as many others as possible as capable of giving much more even if there were no restrictions and if the restrictions remain still give with joy. To make people such that for as many as possible giving to others would be understood to be a win-win. And I feel that that might have the goal of David Brooks as well in writing his essay. But I would really have liked him to say with even a stronger voice: "We need to repent!"