How does the COA/COO idea, or state capacity libertarianism in general, get around the Public Choice incentives of concentrated interests pushing for subsidizing demand and restricting supply? It is not obvious to me how their incentive structure helps them avoid that, either at the regulatory capture end or the generalized begging for subsidies end.
The Democrats understand how important language is. All who care about these problems should be calling them Government Choice problems, not "Public". It's government schools, building, parks, and government choices which are creating so many problems, not so much the choices of the normal folk, the public.
Allowing government schools to indoctrinate kids into believing how good and important are government benefit, so important that they become moral "rights", entitlements, has created a monster of gov't spending (more demand), gov't regulation (less supply), and far far less individual responsibility.
Freedom to act, adult freedom with responsibility, vs. freedom FROM responsibility, so others pay for any mistakes - with restriction on actions. The gov't spending goes to allow "more equal freedom". The regulations are to reduce, thru restriction, the ability of folks to make mistakes. But the regulations more often restrict good action, while allowing plenty of irresponsible mistakes to be made.
When high level gov't agents make mistakes, like the Fed on inflation, they seem to receive childish freedom from responsibility - so it's no surprise that everybody else wants that freedom, too.
Do you really think that the desire to subsidize health insurance for people for whom it is not subsidized through employer provided insurance originates with health service providers? Or even insurers? In fact the whole idea o employers purchasing insurance for their employees was just a way of getting around wartime wage controls, not something cooked up by doctors. Public Choice does explain a lot of things, but does not look like one of them.
Thank you for the post. Every time you post on Public Choice, it helps me understand it better. Even people who see themselves as non-members of the “free lunch” club tend to see their own government benefits as righteous. They’re only against the subsidies *other* people get. It’s also no surprise that concentrated interests are really good at getting the people in charge of the systems that benefit them to increase that benefit. To expect either to change would be to seek the invention of different humans. I’m not sanguine that will happen anytime soon.
Seems like they are against moving costs into the public sector. So they are on your side, to first order, And so why get worked up because they might have second order stuff wrong?
Often, as in my industry, private rent seekers are acting on behalf of citizens against the government. For instance, MAPD is in many ways an attempt to exploit government loopholes to increase benefits to citizens at increased cost to government. In exchange for helping members exploit those loopholes the insurer gets to keep 15% (and if it also owns the provider, far more).
But who wants to tell dual medicare/medicaid eligibles that they can't get $0 copays on absolutely everything, free car rides, free groceries, free premiums, free drugs, and free debit cards to spend on whatever they want. The government complains about cost growth, but try cutting any of these benefits and watch what happens (members leave and complaints to CMS make your life a nightmare). The member doesn't care if the Medicare Trust Fund takes a hit, and honestly CMS doesn't either.
The government obsesses over the 15%, without recognizing that if profit levels are restricted then driving up medical cost trend is the only way to increase the bottom line, because 15% of a bigger number is a bigger number.
I haven't had the chance to read the whole thing, but the introductory paragraph you quoted clearly seems to be saying "DON'T SUBSIDIZE DEMAND because THE RESTRICTED SUPPLY IS CAUSED BY REGULATION".
The Niskanen Center at this point are pseudo-libertarian progressives. I take what they're saying as good, because they're talking to an audience that needs to hear this. I guess to me it doesn't matter if they're glazing over the minutiae of the argument when they're getting the big picture correct. That's the most likely way they're going to make any headway, if it's possible, with a more general audience (progressives) that don't want to hear any of this.
The one solution that would seem reasonable would be to subsidize demand as much as possible by providing consumers with funds they use directly with only the broadest restrictions. Since money is fungible it doesn't matter to me if I get dollars restricted to health care as long as I can save them and spend them as I like (an HSA, basically) and will still largely avoid restricting supply. Even school vouchers directing government funding would avoid the problem reasonably well. The inevitable issue is leftists, social conservatives, and 'supply side libertarians' all get worried that people are going to spend the money on the *wrong thing* and play directly into the hands of our version of the oligarchs by narrowing choices and nudging people into doing the *right thing*, which usually just means giving the oligarchs business (see the Obamacare insurance requirement)
How does the COA/COO idea, or state capacity libertarianism in general, get around the Public Choice incentives of concentrated interests pushing for subsidizing demand and restricting supply? It is not obvious to me how their incentive structure helps them avoid that, either at the regulatory capture end or the generalized begging for subsidies end.
The Democrats understand how important language is. All who care about these problems should be calling them Government Choice problems, not "Public". It's government schools, building, parks, and government choices which are creating so many problems, not so much the choices of the normal folk, the public.
Allowing government schools to indoctrinate kids into believing how good and important are government benefit, so important that they become moral "rights", entitlements, has created a monster of gov't spending (more demand), gov't regulation (less supply), and far far less individual responsibility.
Freedom to act, adult freedom with responsibility, vs. freedom FROM responsibility, so others pay for any mistakes - with restriction on actions. The gov't spending goes to allow "more equal freedom". The regulations are to reduce, thru restriction, the ability of folks to make mistakes. But the regulations more often restrict good action, while allowing plenty of irresponsible mistakes to be made.
When high level gov't agents make mistakes, like the Fed on inflation, they seem to receive childish freedom from responsibility - so it's no surprise that everybody else wants that freedom, too.
Do you really think that the desire to subsidize health insurance for people for whom it is not subsidized through employer provided insurance originates with health service providers? Or even insurers? In fact the whole idea o employers purchasing insurance for their employees was just a way of getting around wartime wage controls, not something cooked up by doctors. Public Choice does explain a lot of things, but does not look like one of them.
Thank you for the post. Every time you post on Public Choice, it helps me understand it better. Even people who see themselves as non-members of the “free lunch” club tend to see their own government benefits as righteous. They’re only against the subsidies *other* people get. It’s also no surprise that concentrated interests are really good at getting the people in charge of the systems that benefit them to increase that benefit. To expect either to change would be to seek the invention of different humans. I’m not sanguine that will happen anytime soon.
Seems like they are against moving costs into the public sector. So they are on your side, to first order, And so why get worked up because they might have second order stuff wrong?
Often, as in my industry, private rent seekers are acting on behalf of citizens against the government. For instance, MAPD is in many ways an attempt to exploit government loopholes to increase benefits to citizens at increased cost to government. In exchange for helping members exploit those loopholes the insurer gets to keep 15% (and if it also owns the provider, far more).
But who wants to tell dual medicare/medicaid eligibles that they can't get $0 copays on absolutely everything, free car rides, free groceries, free premiums, free drugs, and free debit cards to spend on whatever they want. The government complains about cost growth, but try cutting any of these benefits and watch what happens (members leave and complaints to CMS make your life a nightmare). The member doesn't care if the Medicare Trust Fund takes a hit, and honestly CMS doesn't either.
The government obsesses over the 15%, without recognizing that if profit levels are restricted then driving up medical cost trend is the only way to increase the bottom line, because 15% of a bigger number is a bigger number.
I haven't had the chance to read the whole thing, but the introductory paragraph you quoted clearly seems to be saying "DON'T SUBSIDIZE DEMAND because THE RESTRICTED SUPPLY IS CAUSED BY REGULATION".
The Niskanen Center at this point are pseudo-libertarian progressives. I take what they're saying as good, because they're talking to an audience that needs to hear this. I guess to me it doesn't matter if they're glazing over the minutiae of the argument when they're getting the big picture correct. That's the most likely way they're going to make any headway, if it's possible, with a more general audience (progressives) that don't want to hear any of this.
The one solution that would seem reasonable would be to subsidize demand as much as possible by providing consumers with funds they use directly with only the broadest restrictions. Since money is fungible it doesn't matter to me if I get dollars restricted to health care as long as I can save them and spend them as I like (an HSA, basically) and will still largely avoid restricting supply. Even school vouchers directing government funding would avoid the problem reasonably well. The inevitable issue is leftists, social conservatives, and 'supply side libertarians' all get worried that people are going to spend the money on the *wrong thing* and play directly into the hands of our version of the oligarchs by narrowing choices and nudging people into doing the *right thing*, which usually just means giving the oligarchs business (see the Obamacare insurance requirement)