Sunday, January 25, 2015

The quality of mercy is not Strain

Emily Trask and Chelsea Steverson as Shakespeare's defense attorneys in The Merchant of Venice, Utah Shakespeare Festival, 2010.
This is just so perfect, from Michael R. Strain of the American Enterprise Institute, in the Wapo today:

End Obamacare, and people could die. That’s okay.

It is such obvious trolling that you might think it best not to encourage it by paying it any attention, and yet the argument is bound to have a certain appeal to your 19-year-old dorm-room libertarian, so I think it's worth while pointing out that it's wrong.

What the argument is, basically, is that we do that kind of stuff all the time. For example, people die because we don't mandate a 10 miles-per-hour speed limit on our highways, which would make it really hard, according to Strain, to kill people with a car. Or
A sentry on every street corner and a government-monitored camera in every private room and hallway in America would significantly lower the homicide rate.
Which is virtually identical to requiring people to buy health insurance that they can afford.

But in reality, as Strain correctly suggests, the US government's cost-benefit analysis really does include the "value of statistical life" (VSL) saved by a given policy as part of the benefits it weighs against the policy's potential costs, which sounds pretty ugly, because they will recommend not saving x many lives if they think it would cost too much, and in that sense are genuinely making these life-or-death decisions on these grounds, as you might price a slice of pizza—though they're only statistical lives, of course, not anybody's life in particular.

But most of the benefits Strain cites for repealing the Affordable Care Act are not part of any possible calculations:
— including more cash for other programs, such as those that help the poor; less government coercion and more individual liberty; more health-care choice for consumers, allowing them to find plans that better fit their needs; more money for taxpayers to spend themselves; and less federal health-care spending.
Actually, no, it does not arguably include almost any of these things, since
the CBO said in a May 14, 2013, blog post that its most recent prediction of the act’s total budget impact was a July 24, 2012, estimate that repealing the law could raise the federal deficit by $109 billion ($111 billion in 2013 dollars) from 2013 through 2022. (PolitiFact Texas)
So that repealing the ACA would in fact leave less cash for other programs, such as those that help the poor, and more federal health-care spending; and I don't see how the patients would get more choice out of losing all the subsidized-care options, which typically fit your needs a good deal better than paying full price when you're on a budget, and leave you a good deal more money to spend yourself. And the individual liberty isn't easily quantified, but I feel a lot freer if I'm insured.

(Repeal would of course leave more money in the pockets of people who refuse to buy health insurance, at least they'd have more money as long as they never got sick or had an accident, but since these constitute only some fairly small fraction of the 16.7% of the population who would be uninsured without the ACA, i.e., excluding the millions who did and still do want subsidized health insurance or expanded Medicaid, I kind of doubt their extra pocket money would make that much of a difference compared to the $100-odd billion repeal would cost the nation. In addition to which this tiny minority of selfish shits who could afford to buy health insurance but won't because they hope, if they ever do get sick, to get charity care at government expense, are exactly the ones who knowingly want to get rid of the Act, as opposed to the simple-minded rednecks who are merely afraid of it because it's Black.)

Still more important is the fact that the victims of repeal, the people who will die because Strain incorrectly thinks (or pretends to think) that they cost too much money, are not as much of a statistical abstraction as Strain affects to believe, because we know quite a bit about them: they are survivors of deadly diseases like cancer who would not be able to buy insurance without the ACA because of their "preexisting condition"; people whose ruthlessly stingy employers refuse to supply them with normal employer insurance; and people who are just too poor to get health insurance but not poor enough to get Medicaid, now covered under the expansion in those states whose governors aren't cruel enough to keep it from them, lost if the Act is repealed (the latest estimate is between 7,000 and 17,000 deaths so I guess repeal would more or less double that). They're poor people in the main.

It's very nice to talk about the anonymous and arbitrary VSL that will be lost if some piece of legislation goes through, but it's different when you know who they are. Imagine a bill turning to have as an unexpected consequence the death of some small but fixed percentage of the employees of conservative think tanks—no, don't, that's too much fun.

But the repeal of the ACA isn't just going to kill people, it's going to kill them for being poor, and that's not something Congress is supposed to do.

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