Wednesday, January 20, 2010

Hit the "Reset" Button

I didn't blog in great detail about the Senate's version of the health-care bill. A short summary is that I thought it was superior to the House version in principle but that it collapsed into a morass of special interest deals and unintended consequences that made it one of the worst pieces of legislation I've seen since I worked in the U.S. Senate in the 1970s. The unexpected election of Scott Brown in the Massachusetts U.S. race seems to afford a window for Congress to go back to the drawing board and produce a truly bi-partisan and measured piece of legislation.

So, what would I actually recommend (after all of these posts commenting on what other people have proposed)? I thought about this last night, and I think, if I were the new health-care-reform czar (presumably the President will want to listen to some new advisors after the Massachusetts election) here is what I would propose:

1 ) Get Republicans on board with two things that they think are important:

a ) Use the Interstate Commerce power of Congress to stop states from restricting interstate sales of medical insurance. Specifically, deny the states the power to insist on expensive bundles of mandates. Fire up a market for no-frills insurance, what in my parents' day was called "major medical" insurance. Let the medical insurance companies compete on price and quality like GEICO and Progresssive and Allstate do on automobile insurance.

b ) Include tort reform to restrain the costs of medical malpractice insurance.

2 ) Keep the "Cadillac tax" idea from the Senate bill, but make sure that the cut-offs are indexed for inflation.

3 ) Estimate the revenue gained from # 2) above. Call this revenue $M. Get together a top-rated collection of health economists, and tell them that they have $M to work with, and ask them to design a system with the following three possible uses of that money to find the most effective and least disruptive ways to expand current medical insurance access:

a ) Return the money to the states so that they can increase the Medicaid eligibility limits. In other words, don't impose unfunded mandates on the states such as the ones that led to the infamous "Nebraska exception". If we want states to expand Medicaid, provide them with the money to do so.

b ) Offer a refundable tax credit for individual purchases of medical insurance.

c ) Use the money to require the interstate competitors (see # 1 above) to participate in a "high-risk" pool for people with prohibitive pre-existing conditions. (This is similar to how many states deal with "high risk" drivers.) This might include a new mandated "no-pre-exisiting-condition-exclusion" benefit for anyone who is covered by any sort of insurance policy as a child, and who agrees to stay in some policy as he/she becomes an adult.

Tuesday, January 19, 2010

More on Haiti

Most of the day I work through large stack of books, journal articles, practice problems, and tidy my power point slides for lectures. The earthquake in Port-Au-Prince did not reach my awareness until my fantastic news-junkie friend reported the story at Bible Study later that Wednesday night. Our collective response was in prayer for Haiti ---I do not know each person's individual response. However, throughout the Florida State University campus there were visible signs that Haiti was on our student's minds. There was a troubador strumming out Jeff Buckley's "Hallelujah" outside the union with an open guitar case and an 8.5x11 piece of paper posted to the inside stating the cause. In front of Strozier library a young girl was collecting donations in a plastic jug and passing out information about the various donation texting campaigns to make contributions easier (Red Cross received $18 Million in donations via text!). The outpouring was enormous. But, in the wake of the disaster there are the simple problems Mark reported in the last post: coordination between the many agencies and allocation of correct resources (for example, only 40% of the drugs given during the Tsunami Relief effort in Indonesia were drugs needed by the people we were trying to help).

Here is an article by Laura Freschi at NYU titled, "Getting Humanitarian Relief Right" about what we can glean from previous natural disasters. More than anything I hope that the devastation that came from the earthquake creates a fluid situation in which major informal reforms of the heart and formal reforms of governance and policy flourish. Along these lines is a quote I read from my friend Brandon Vogt's blog (The Thin Veil):

"Hopefully this tragedy will bring about a new national unity among the Haitian people who have been long divided over class and or political lines. And for us in the United States, let me say that geography has made the U.S. and Haiti neighbors; now is the time that we show that we also are truly brothers and sisters." -Bishop Thomas Wenski

Thursday, January 14, 2010

Wealth and Saftey II

Here is another thoughtful post on Haiti. The more I read about this, the more I wonder if unprecedented action is called for. If the United Nations ever has any role to play, it ought to be here. I'm beginning to believe that the U.N. Security Council ought to declare Haiti an Emergency Mandate. And, no, I don't think the people at the U.N. are able to run Haiti. But France has a good track record in stabilizing former colonies. If the cultural problems of having France temporarily govern a country that fought early on to liberate itself from French rule are too immense, then there may some other country with similar skills: Japan? Brazil? Great Britain? Norway? As I said, if this isn't where the U.N. can do something bold and constructive to quickly address an international disaster, I'm not sure why we even have a U.N..

Wealth and Safety

There are numerous links across the web today to well-respected aid NGOs who are providing relief for the devastation in Haiti: Compassion International , Food for the Poor , WorldVision , and Presbyterian Global Fellowship are just a few of the sites with which I've had some acquaintance.

In addition to our generosity, we should remember Paul Collier's warnings from the time of the Asian Tsunami: westerners (and I suspect that Americans would definitely be included in this category) are extremely generous in times of great natural emergencies. The crunch comes after many months when the emergency has dropped from the news, and long term problems remain.

In Haiti's case, there were already long term problems. Haiti is the poorest nation in the Western hemisphere, and one of the poorest in the world. And, as is starkly evident, economic prosperity brings with it technological and cultural realities that can drastically mitigate the damaging effects of natural disasters. Examples: in 1989 an earthquake of magnitude 7.1 struck the San Francisco bay area. 67 people died. A similar death toll came from the 6.7 magnitude earthquake in Los Angeles (Northridge, 1994). If we want to help Haiti after the emergency crews go home, we need to think seriously about what we can do to bring Haiti's prosperity up to the level of even other moderately poor countries.

Through Instapundit, I found that Tyler Cowen at Marginal revolution is tackling these questions head on. How is economic prosperity related to safety? Why is Haiti so poor? In the latter post, be sure to read the free-wheeling discussions in the comments section. In a newer post, he links to a New York Times article about building construction in Haiti.

Friday, January 8, 2010

Connecting The Dots

Several years ago, economists argued that new computer technologies would allow for decentralized information signals to be gathered about terrorist activities around the world. The system lasted just a few days after becoming public, after virtually all of our political elites denounced the idea as "terror markets." I was just thinking how things might have been different over the past few months if people with on-the-ground information had been able to disseminate signals about activities behind the scenes of the Ft. Hood shootings and the underwear bomber.