Planet Utah

What they say about cap and trade

You've read my primary criticism of cap and trade here. (Actually, calling it "mine" isn't quite right. I lifted it from stuff I'd read and found persuasive.) It goes like this: Unless the world's other big economic powers implement similar cap-and-trade regimes, anything the U.S. does will produce almost no benefits in terms of global warming, but will have significant costs.

I've been surprised to find very little challenge to this premise on the left. That surprises me because in today's politics, advocates don't often let the truth stand in the way of their position. But from what I've read, it seems to me that the left is conceding the truth of the argument above.

So, why go ahead with cap and trade? Various lefties are making this case: Only by adopting a regime of our own will we have the authority to say to China, India, Russia, Brazil, Japan, Chad, Madagascar, and the tiny little Duchy of Grand Fenwick, "Hey, you all need to step up to the plate and do this, too."

And you know what? It's definitely true that with no regime of our own in place, other countries can say, "If it's such a great idea, why don't you go first?"

The question is, though, whether going first will actually get us anything. Conservatives say no. They say that by going first, we'll be giving up any negotiating leverage we might have had. Without cap and trade, we'd have cap and trade to offer: "Hey, China, if you do cap and trade, we will too." But with cap and trade already in place, we've lost that leverage.

These competing arguments represent two very different ways of looking at the world, and two very different assessments of how people, and entire nations, make decisions.

Who's right? I don't know. I do know, however, that if we go first and fail to get the rest of the world to go along, we're in a pickle. If we don't go first, though, and we then try, and fail, to get the rest of the world to hold hands with us and jump off the bridge together, we can always adopt cap and trade on our own, and return to the negotiating table with the authority that the left says we need. This seems like a much more sensible approach to me.

Footnote: For what it's worth, I think most political scientists--bolstered by game theory and their assumptions about the self-interested behavior of political actors--would side with the conservatives here. They'd look at the U.S. going first and predict that the rest of the world would respond in unison: "Suckers!" But according to their rational actor assumptions and their game theoretic models, nobody should vote on election day, either. So, you can't take them (I mean, us) too seriously.

Anklenote: Lehigh, you know rat choice and game theory much better than I, so please correct me if I'm wrong. Just be sure to address me as "Doctor" when you do...

The tired old "judge not" debate

I haven't blogged about religion very much in recent months, mainly because I've achieved a degree of peace when it comes to the issues I had been struggling with. Actually, it would be more accurate to say I've achieved a state of clear. That's what we call it in the Church of Scientology.

Just kidding, Mom and Dad! I mean, really, who can afford their own e-meter? (Actually, I have achieved a degree of peace, but I'll save that for another post.)

So, anyway, today I was listening to talk radio, and apparently some congregation got kicked out of some institutional church somewhere for somehow appearing to condone homosexuality. Well, the one side said, "Homosexuality is sinful behavior. You can't claim to be a Christian church and condone sinful behavior. So, if that's what the congregation was doing, they deserve what they got." This prompted people on the other side to call in and say, "Who are we to stand in judgment of others? Jesus said, 'Judge not, lest ye be judged.' The only one with the power to judge is God. If homosexuality is sinful, then God will judge homosexuals at the end of time. It's not our business to judge them in the here and now."

The problem I have with the latter response is that it glosses over the difference between judging people and judging behavior. My own interpretation of Jesus' teaching is that it is not our place to judge people, i.e., to say, "You are a good person," or "You are a wicked person"; only God can do that. I think Jesus is okay, however, with judging behavior. In fact, he gives explicit instructions for what to do when "your brother has sinned against you." Following those instructions requires that: a) we be able to identify sinful behavior in our brother; and b) that we point it out to our brother with an expectation that the behavior will change. We are, in other words, judging the behavior as bad and in need of change, and we are saying so.

This leaves open the question of what to do about sins against God. Homosexuality, for example, isn't a sin against ME, but it is a sin against God (or God's design), at least if you take Leviticus seriously. (And for those of you who think that Jesus didn't take Leviticus seriously, at several places in the Gospels he expressly affirms the continuing relevance of "the law," i.e., the Torah, i.e., the first five books of the Bible: Genesis, Exodus, Leviticus, Numbers, and Deuteronomy.) In Leviticus, God calls homosexual sex an abomination, a detestable act, an enormous sin...depending on the translation you prefer.

So, for those who insist that we not judge sins against God, you are saying that our thought process should run as follows: "Well, God says this behavior is an enormous sin, and God says that this behavior is punishable by death...but I'm just not comfortable condemning it. Call me crazy..."

In my mind, that WOULD be crazy. If God condemns the behavior and requires us to be the instrument of civil justice in response to it (i.e., to stone people who engage in it, at least in Leviticus times), is it a reasonable expectation that we are not supposed to condemn the behavior as well? I don't think so...

Footnote: In preemptive fashion, let me acknowledge that Jesus also offered abundant cautions about judging the sins of others when we ourselves are engaged in sinful behavior. He was particularly sensitive about the Pharisees, whose condemnations of sin were public, and whose self-righteousness was also public. And he was a big believer in forgiving and forgetting rather than bearing grudges. But I don't think Jesus preached that we should never identify and condemn sin in others.

Anklenote: Would I be comfortable calling out someone else's sins? In certain circumstances, yes. It would have to be a pretty serious sin, it would have to be part of a pattern of behavior (not just a one-off thing that would never happen again), and the sin would have to be something of which I was not guilty myself. (That's the plank-in-your-own-eye caution.)

Did I mention that I solved the health care crisis?

I did. Surprisingly, it wasn't that hard.

The two things Democrats want most are: (1) universal coverage; and (2) a "public option," that is, a new, "Medicare-like" program into which non-elderly, regular Janes and Joes could opt. (I am self-consciously using quote marks here on phrases that have become so common in this debate as to seem trite. Rest assured, though, I will not be using the phrase, "bend the curve.")

So, let them have those two things.

The two things Republicans want most are: (1) individual choice; and (2) portability. (They consider the former a good thing in and of itself, but also good in that it creates a more robust health care market, which should result in lower prices, higher quality, etc. They consider the latter a good thing because it means no one will be stuck in a job they don't like or a state they don't like for fear of losing their insurance.)

So, let them have those two things.

Immediately, Republicans will object: "If you allow a public option, you already know what's going to happen. The federal government will insist on a Cadillac plan but will only pay Malibu prices. Health care providers will then charge private insurers more to make up for the money they're losing on the public option. Not only does this put private insurers in an unfair competitive position, it also does nothing to control health care costs. You're just squeezing the balloon again."

Here's how you fix that problem: Everyone will have to pay something for the health care plan they choose, and because there's going to be a net cost involved in all of this, what they pay will have to be more than what they pay today.  This added cost could take the form of higher deductibles/co-pays, a straight tax assessment, a premium, whatever. However you structure it, though, the amount you pay for your plan will be directly proportional to the value of the plan benefits, as determined by some independent entity. And the plan will be valued not just on the basis of an abstract basket of benefits it claims to provide, but on the benefits it actually provides in practice. If plan providers order up a full-body CT scan every time I go in, I'm going to have to bear part of the cost for that. If, on the other hand, plan providers never run any tests, and instead just encourage patients to eat an apple a day, I'm going to enjoy some of the savings from that.

What does this approach do for you? First, it establishes a more direct connection between the cost of health care and the costs that health care consumers pay. If you want more/better, you can have it, but you will have to pay more. That will help keep spending in check.

Second, this pricing scheme keeps the federal government from cheating. Politicians will be able to control the public plan, and their natural inclination will be to provide fantastic benefits, charge small premiums, and then say to voters, "See what we did for you?" All they really will have done, however, is disadvantage private insurers and rack up more debt. But if the consumer costs associated with the public plan are based on the value of plan benefits, then a Cadillac public plan will cost the consumer the same as a Cadillac private plan. In other words, politicians won't be able to cheat. The public plan and the private plans will have to compete on equal footing.

So, both Democrats and Republicans give a little but get a lot. Health care consumers, on the other hand, are mostly going to be giving; you can't enroll tens of millions of new people in the system and not expect it to cost something.

The question is, are our politicians grown up enough to level with the American people, to tell them that they can't have something for nothing? Probably not...

What Sarah Palin should do now

Go on Letterman! I'm serious. It would show that she was a big enough person to forgive and forget, and it would undoubtedly draw huge ratings--and introduce her to an audience that doesn't normally get to see her. And if she was gracious and funny, she would probably win over a lot of people. It might turn into a fresh start for her.

Footnote: As long as she doesn't talk about flowing oil and natural gas into hungry markets...

My own little health care story

Almost 10 years ago now, I became self-employed. I didn't know how long that status was going to last, but I figured I better buy my own health insurance. I got an individual policy, and the premium was about $110 per month. I remember thinking at the time how expensive that was, and how they had really jacked up the price because of some comparatively minor health issues I'd had in the past. In retrospect, I consider the premium to have been remarkably cheap.

Ten years later, I have that same insurance. The premium is now $155 per month--still very cheap, if you ask me. Since 2000, however, I have developed some chronic health issues. They don't require much in the way of doctor's visits, but I do have to take assorted medications. Those cost me about $200/month, with insurance covering the rest. I have various co-pays and deductibles for provider visits and tests, and if I want to see a specialist, sometimes I just refer myself and pay cash rather than going through the hassle of seeing if my doctor will refer me. But all in all, my insurance coverage is adequate, it gives me peace of mind, and I consider myself fortunate to have a policy I can afford.

The policy is not ideal for me, though, for a few reasons that I won't get into. Because it's not ideal, I started shopping for a new policy about six months ago. I found one that I liked, and I applied. DENIED. Why? Because of the medical conditions that I mentioned before. So, I called an insurance broker and asked for help. She found a company that would insure me, but: (a) the policy they wrote would exclude coverage--permanently--for my pre-existing medical conditions (which were the source of the previous denial); and (b) if the frequency/cost of the treatment for those conditions increased between now and the time the company received my application, they would deny me insurance coverage altogether. 

In other words, under the new policy I would be paying for 100 percent of the medications/ treatments related to my pre-existing medical conditions (whereas under the current policy those conditions are covered, and I only have to deal with the co-pay and deductible); and if those conditions should worsen before my new policy is approved, it's not going to be approved at all.

I probably don't need to tell you that I decided to keep my current policy, and that I consider myself lucky to have it. Basically, though, I'm stuck with it, although there are things about it I don't like. And I'm probably stuck with it even if I take a job some day with an employer who provides insurance. Why? Well, what if I leave that job? I can keep the coverage under COBRA, but that could be massively expensive, depending on what my employer was paying in premiums. If I decided to quit my COBRA coverage and reapply for individual insurance, I'd be in the boat I described up above--unable to get the kind of coverage I have now. So, even if I am some day able to get insurance through another source, I'll probably need to keep my individual policy, just to be on the safe side.

So what? So nothing, really. I assume that most of my readers, like most people, have insurance through their employer or through a government program (or both). If so, you've probably experienced your own set of problems, anxieties, frustrations, and headaches. I just wanted to give you a semi-personal look at some of the issues experienced by those of us who have individual insurance policies.

Footnote: And I wanted to suggest to you, by inference, the kinds of problems I'd be having if I had NOT bought an individual insurance policy before I began to have chronic medical problems. It's not an exaggeration to say that I would have been personally responsible for tens of thousands of dollars in expenses that instead have been picked up by my insurer. Or I might simply have gone without treatment. 

Eleanor, Eleanor, Eleanor...

I don't often watch the McLaughlin Group, but I flipped it on today while I was folding laundry. Eleanor Clift from Newsweek said this: "Domestic terrorism is as great a threat to this country as Islamic terrorism." Her evidence? The Oklahoma City bombing. That's it. (Granted, the format doesn't lend itself to extended presentations.)

When Monica Crowley declared Eleanor's assertion "absurd," Eleanor said, "Calling it 'absurd' doesn't qualify as political analysis."

Neither, however, does the initial claim. If Eleanor wanted to try to back it up, here are the three kinds of proof she'd have to provide: (1) proof that there is a group, or groups, in the United States that have the same designs on the U.S. and its interests, both domestically and abroad, that Islamic terrorists have; (2) proof that this group or groups have a capacity to carry out their designs equivalent to that enjoyed by Islamic terrorists; and (3) proof that this group or groups have the will to carry out their designs equivalent to the will found among Islamic terrorists.

That's your assignment, Eleanor. Good luck with it.

I think somebody wants to flow her state's resources into North America's hungry markets

In my post on Sarah Palin below, I mentioned that like other politicians, she tends to rely excessively on sound bites. To give a specific example, I don't think I've ever heard Gov. Palin talk about oil or natural gas without mentioning the importance of "flowing" these resources from Alaska to the "hungry markets" in North America.

I'm not sure when the governor's birthday is, but I've got a great gift idea: a thesaurus.

Footnote: I was surprised to learn that "flow" can, in fact, be used as a transitive verb. But it sounds pretty ugly to my ear.

No blood for oil indeed

Before the second Gulf War began, you could see bumper stickers and t-shirts that said, "No blood for oil." The implication was that we were going to war with Iraq because it possessed very large reserves of a very important resource: oil.

I was never able to figure out the logic underneath or behind that simple statement of cause and effect. My most intellectually honest attempt to understand it went something like this: Iraq possesses the world's third-largest oil reserves. Iraq, however, is an enemy regime. Because of that, we can't count on it to sell us oil. But we need oil. If we go in and install a friendly regime, we can be sure that Iraq will sell us its oil. So, we better go do that.

Okay, fine. Let's assume that Saddam Hussein had the luxury of not selling any oil to the U.S. (heroic assumption, but whatever). Would we care? Not really. The market price for oil is set by some combination of supply, demand, speculation, and OPEC price-fixing. The Iraqis' hypothetical decision not to sell oil to the U.S. doesn't affect any of these things. If Saddam wants to sell 30 kajillion barrels of oil to China rather than the U.S., that means that China doesn't have to buy those 30 kajillion barrels of oil from someone else. And that means that someone else has 30 kajillion barrels of oil available that they were hoping to sell to China, but now can't sell to China b/c Saddam beat them to it. So, the U.S. steps in and says, "We'll take that oil off your hands."

Analogy: One night I get drunk and obnoxious and get kicked out of a liquor store near my home. The owner tells me, "Don't ever come back here. We don't want your business." I say, "No problem. There's another liquor store up the street, and another, and another..." And I'm exactly right. One liquor store's decision not to sell booze to me doesn't affect my personal access to booze, or the price I'm going to pay for it. That liquor store's loss is some other liquor store's gain.

Maybe the "No blood for oil" crowd had a far more sophisticated argument in mind. I don't know, because I never heard Viggo Mortensen or Janeane Garofalo present an actual argument on the subject. But if you want proof that they were wrong--no matter what their argument was--all you need to do is look at historical crude prices from 2003 through today. Average, inflation-adjusted crude oil prices have, for most of the post-invasion period, been dramatically higher than they were before we went into Iraq. Today, with a friendly, democratically-elected regime in Iraq, with the U.N. restrictions on the country's oil sales lifted, and despite the 2008 nose-dive in oil prices that cut the cost of a gallon of gas in half, oil prices are still more than twice what they were before we went to war with Iraq.

If the second Gulf War was about ensuring plentiful supplies of cheap oil to the U.S., it looks like a pretty spectacular failure.

Footnote: Or, maybe it wasn't about that in the first place. Whaddya think, Viggo?

Sarah Palin: It can't just be me, can it?

I watched Sarah Palin's interview with Matt Lauer this morning and found her to be very much the same person she was at the end of last year's campaign: smart, tough, funny, genuine, articulate, and thoughtful. I thought she was every bit as good as any national politician one might encounter on the Sunday morning news/political shows. That means that while she is not unusually gifted for a politician of her stature, and though she does some unfortunate things that many politicians do--talks around the truth, relies too much on pre-packaged sound bites, etc.--she deserves to be taken seriously and not to be dismissed as a bimbo, a MILF, a poster girl, a "slutty flight attendant," an affirmative action hire (as McCain's running mate), or anything of the sort.

Footnote: One of the developments I really, truly regret in modern American politics is the unwillingness/inability to disagree agreeably; to see one's opponents as thoughtful and well-intentioned (if wrong), until they prove otherwise; and to respect other people and viewpoints rather than simply dismissing them as so self-evidently wrongheaded as not to merit anything more than a roll of the eyes and a wave of the hand.

One manifestation of these developments is that some people reading this post will assume that I'm unable to look at Sarah Palin objectively--that, ironically, my viewpoints are a product of the very developments I've just lamented, that is, that my opinions are determined on the basis of ideology rather than evidence, that my ideological filters let in only favorable information on the things I'm predisposed to like, etc.

Well, over the course of 10 years of blogging, though I've established that I'm quite conservative, I'd like to think I've also established that I'm open to ideas and opinions that don't fit with my view of the way the world should work. Here's some proof:

• I think Sarah Palin's performance in her interview with Katie Couric was lousy, and I think that was largely Palin's fault (or the McCain campaign's fault, if the bad performance was the result of excessive programming on their part), not Katie Couric's.

• I think Palin went too far in her response to David Letterman's apology-cum-invitation, in which she said that she would not appear on his show, in part because she wanted to keep her 14-year-old, Willow, away from the late-night host.


• While I think Palin was an acceptable choice as McCain's VP, and while I think she performed admirably under the circumstances, I don't think she was the best choice--Mitt Romney would have been--and, in retrospect, I don't think she was ready. (I expressed my skepticism about her readiness on the day the pick was announced, and I'm still not sure she's ready to be president.)

Just to open up the philosophical vista a bit:

• I don't think Hillary Clinton is a lesbian.

• I don't think Vince Foster was murdered.

• I don't think the Clintons' marriage is simply a business arrangement.
  

• I don't think Barack Obama is: (a) a socialist; (b) a Muslim; or (c) a citizen of Kenya.


• I don't think George W. Bush was a good president.

And yet, I still think Sarah Palin is a serious, talented person who ought to be treated with respect. I sincerely hope that induces cognitive dissonance in some of you.

An important health care policy change

Pre-script: If you read only one health care-related blog post this year...you've obviously got your priorities straight. Seriously, though, if you're the sort who thinks that the need for universal health care coverage in America is a no-brainer, I hope you'll take the time to work through this post. I know I'm not going to write you off of your position, but I think you'll at least see that this issue is, in fact, a "brainer."

And away we go...

The last time we had a serious debate about U.S. health care was 1993. At that time, the GOP took a "just say no" approach and prevailed.

This time, though, I see and hear prominent Republicans embracing universal coverage as an important element of any major reform. That's a big change, and a welcome one as far as I'm concerned. I welcome it not just because I'd like to see the U.S. have universal coverage, but because if conservatives/Republicans excuse themselves from this discussion, we're more likely to get some version of Kennedycare than a more sensible reform.

Footnote: If anyone told you that we were going to make sure everyone in America had a house of their own, and at the same time that we were going to control the growth of housing prices, you would say, "Cool. And when you're done, can you send a fat-free pizza and an invisible chocolate unicorn to my affordable new house?"

It just doesn't make sense that you can dramatically increase the demand for something and not expect the price of that something to go up. That's why you are correct to be skeptical about the Obama administration's claims that it will achieve universal health care coverage while at the same time keeping costs in check.

The Obama people would undoubtedly tell you, "But there are all sorts of steps we can take to hold the line on prices: making medical records electronic, emphasizing preventive care, researching and disseminating knowledge on the most effective treatments..." Truth is, though, no one knows whether, or to what extent, these things will work to restrain prices. But you gotta say something about how you're going to restrain prices, and it looks like this is the something the Obama administration is going to say.

And if it doesn't work? Well, that's someone else's problem. Obama still gets credit for bringing us universal health care. (Analogy: George W. Bush gets credit for knocking off the Taliban in Afghanistan; Barack Obama has to deal with the very messy aftermath.)

Anklenote: But if the government is such a big player in healthcare--and poised to get even bigger--can't it dictate prices?

Sure, and it already does that to a certain extent. It pays a lot less for services provided under Medicare, for example, than private insurers pay for those same services.

But government can't suspend the laws of physics, or economics. If you squeeze a balloon on one end, the other end gets fatter. And if you constrain payments in a massive public program like Medicare, doctors, hospitals, and other providers simply raise them elsewhere--most notably, in the fees they charge to insurers and (especially) the uninsured.

Shin-note: Okay, well, if that's the problem, then what if there were no private insurers, because government decided to pay all the bills, and what if there were no uninsured, because as the one paying all the bills, government decided to pay the bills for the previously uninsured, too? Wouldn't that solve the problem of cost-shifting?

Sure, that's what single-payer systems are all about. Government is the only game in town as far as paying for services, so when government sets a price, that's the price that gets paid. Problem solved, right?

Not so fast. When government starts setting prices--and, inevitably, setting them substantially lower than the market would set them, just because it can--you have a lot of smart, ambitious, disciplined people who otherwise would have gone into medicine saying, "You know, that's not nearly as attractive a career as it used to be. I think I'll be a shrimp boat captain instead." And you have a lot of entrepreneurial individuals and companies who otherwise would have operated hospitals and other treatment centers saying, "You know, that's not nearly as attractive a business as it used to be. I think I'll start an ostrich ranch instead." And then you start getting serious shortages of medical goods and services. You also get a decline in the quality of those goods and services, as the people providing them are not as smart, ambitious, or disciplined as the people that used to provide them.

Knee-note: Okay, well, if that's the problem, then why not just have government set prices at a level high enough not to create these disincentives? Won't that solve the problem?

Yes, but only in theory. As you might imagine, running things this way is HUGELY expensive. I mean, you're talking about taking all of the medical bills being paid today by individuals and insurers, and all of the medical fees that providers don't charge in the first place or never collect, and giving government an invoice for ALL of it.

It's a gigantic bill. Government won't want to pay it, and won't be able to without massive borrowing, massive tax increases, or massive spending cuts.

When confronted with options like this, politicians typically choose "none of the above." Specifically, they pick a number--let's say it's 65% of the total bill--and say, "This is how much we can afford to pay. Take it or leave it."

Providers will take it, but they'll also say, "If you're only going to pay 65% of the bill, we're only going to provide 65% of the service."

In practical terms, this means that if 100 people need a kidney transplant, only 65 people are going to get their kidney. Call that what you want, but most people call it health care rationing. It's a fact of life, and death, under single-payer systems. It's the reason you hear about Canadians crossing the border into the U.S. to get health care. It may be crazy-expensive here, but at least you can get it...

Punch-line: To paraphrase C. Everett Koop for about the millionth time in my blogging life, "We all agree that we want first-rate health care, universal coverage, and cost containment. Well, we can't have all three. So, let's pick two and make the best of it."

Again, though, politicians hate having to make choices like that, so they usually convince themselves that they don't have to.