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May 24, 2021Liked by Arnold Kling

When the topic of Government run health care programs comes up, I am always reminded to the scene from the movie Moneyball where Peter Brand (Jonah Hill) tells Billy Beane (Brad Pitt) "You shouldn't be trying to buy players, you should be trying to buy WINS. And to buy wins, you have to buy RUNS"

The government shouldn't trying to buy healthcare. It should be trying to buy HEALTH. And to buy health, you have to buy the things that actually contribute to it. Every health professional in America knows that the biggest contributors to individual health are diet and exercise. The problem is getting people to eat broccoli instead of french fries, and go jogging instead of getting screen-time.

To actually produce the greatest improvement in both longevity and quality of life per dollar spent, the government should end Medicaire and Medicaid immediately and instead replace them with a program of free fresh fruit and vegetables and PAYING people to exercise ($$ per mile jogged, $$ per pound of weights lifted, etc.)

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The benefits of free market health care is quite obvious to most of the educated political right. When McCain ran for President in 2008, he had a good set of free market health care reforms. The Trump Administration did push some good executive level reforms through, like price transparency, but they didn't have the votes or unity to make any legislative changes at all. Also, it seems the free market health care wonks were afraid to credit or affiliate with Trump even when he pushed in the direction they prefer.

The political left is much more powerful today. And they are hostile to free market health care. For example, Andrew Cuomo blasted the Trump Administration for using the private sector including major pharmacy chains to deploy the vaccine. My charitable take, is the left thinks the rich shouldn't have better health care than the poor. My less charitable take, is Democrats are much more interested in building more bureaucracy that entrenches left wing authority than they are in delivering a better health care system to the public.

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Given that people DO have both perspectives, we who what to make changes need to take that into account in how we argue. Too often, we are perceived as having no awareness of "dyad" values or even, as Mr. Baker points out, effects of policy changes on income distribution.

The clearest example of this is minimum wages. When we argue against minimum wages on grounds of inefficiency -- employment loss (even employment loss by the most vulnerable) and perhaps output loss in the most affected sectors (assuming incidence does not fall entirely on employees) -- this gives the impression that we are unaware that the objective of the measure is to transfer income, not to raise wages, per se. Consequently, we ought to argue for a wage top-up like the EITC rather than a minimum wage.

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I don't think this dyad stuff has much to do with why people disagree with you about health care. Progressive people just have more egalitarian values. When it comes to health care, at least, equality of outcome rather than of opportunity is a commonly held value.

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On problem with the consumer choice model is that consumers' choices are filtered through a) which insurance company with which policies are offered and b) which physician with which cost-benefit algorithm they use to turn patient information into prescription of drugs and therapies.

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