McMegan has issued a challenge to proponents of health care reform. On the whole, I think she's got a valid point: if Bad Things X, Y, and Z were happening because we didn't have universal health care, then implementing essentially universal health care should make those bad things go away. And those who claimed Bad Things X, Y, and Z were happening because we didn't have universal health care should at least be amenable to a gentleman's bet that they'll stop happening once the bill that Obama just signed is fully implemented.
Anyhow, her challenge:
I think we ought to be able to work this into a little prediction test. My predictions:
1) Conservatively, Ezra's arithmetic implies a reduction in the
death rate of people between 18-64 of at 20,000-45,000 a year. Let's
take the low bound--20,000 deaths a year--and assume that we should see
that, or something close to it, by 2020. That's about 3% of deaths in
the relevant age group, which would show up as a very noticeably kink
in the death rate. For comparison purposes, the entire fall in
mortality between 1980 and 2000 was about 2.7%.
Contra Ezra, I am predicting that this will not happen. I'm about
75% confident that you will not be able to discern any effect from the
health care reform among the statistical noise. But I am 95+%
confident that the effect will not be as large as 3%.
2) I'm pretty sure that Kristof read the table he was drawing
from wrong--he was looking at life-expectancy at birth, but he
interpreted the data as if it was about adults in the 1940s. Still,
age-adjusted mortality fell about 15% in just 10 years, an achievement
that hasn't been matched since. If Kristof is right, and this had more
to do with health care access than antibiotics, we should be able to
get a similar improvement this time around--especially since we're
already seeing terrific reductions, with a 10% decline in age-related
mortality just between 2001-6. Hell, both Ezra's numbers and
Kristoff's imply that we should be able to knock down the death rate by
at least 20% between 2014 and 2024, when we add their improvements to
the existing trend.
I do not think that there will be a noticeable kink in the trend
line around 2014. The death rate jumps around quite a lot, so there
may be a big drop (or increase) in 2014, neither of which would be
meaningful. By 2025, however, I'm skeptical that we'll see a major
inflection in the trend.
3) David Himmelstein claims to believe that the majority of all
bankruptcies are related to medical issues, and that this is a strong
argument for national health care . . . i.e., he claims to believe that
medical bills rather than income loss are the main causal driver here.
That's the data Michael Moore is citing. I will make a bold
counterclaim: the bankruptcy rate after 2014 will not fall by half. It
won't even fall by a quarter. This is among the easiest effects to
measure, as if the people citing these statistics are right, we should
see a sharp and immediate reduction in bankruptcy rates in the first
year, with the full effects evident by 2018.
4) Infant mortality should be no greater than that of the
Netherlands by 2018. Again, I predict that this will not happen, and
indeed, that infant mortality rates may not fall at all.
5) I predict at least one of the major funding sources, and
possibly all of them, will be substantively repealed: the Medicare
cuts (except Medicare Advantage), the excise tax, and so forth.
6) This program will not reduce the rate of growth in medical costs by anything like 1.5% a year.
7) A fiscal crisis of some sort is quite likely by 2030, though
not just because of this program. But this program will make it worse,
either by increasing the deficit directly, or by using up the
low-hanging fruit that should have funded Medicare reform.
8) By 2030, there's an 80% chance that the government will have
imposed substantial price controls on pharma and other medical
technology--and this will noticeably slow the rate of innovation.
I feel like any reasonable proponent of health care reform should
be willing to take the other side of most of these bets, without
weaseling that this isn't the health care reform that you wanted. If
you aren't confident that we can get at least some of these results,
than we shouldn't have committed to spend $200 billion a year . . . and
you shouldn't have deployed these arguments in the run-up to health
care.
I think I'm willing to take a piece of several of these, although I'm not going to take anything past 2020 here for the simple reason that I feel a hell of a lot more connected with the person I was ten years ago than I do with the person I was 20 years back. If I made a bad call in 2000, I still feel that I blew that call; if I made a bad call in 1990, I don't really care: I was very different then, and that was a long time ago. I expect I'll feel similarly, looking back from 2020 or 2030. So:
1) Megan's "about
75% confident that you will not be able to discern any effect from the
health care reform [on the mortality rates of 18-64 year olds] among the statistical noise." I'm at least equally confident in the other direction.
3) Megan says "the bankruptcy rate after 2014 will not fall by half. It
won't even fall by a quarter." I'll take the other side of that one, too. Adjusted as well as possible for where we are in the business cycle, I'll bet on a 25% drop in personal bankruptcies by 2020, barring further major changes in the bankruptcy laws.
5) Megan predicts that at least one major source of funding will be repealed. I predict if any significant (>10% of reform's costs, individually or in combination) funding sources are repealed, they'll be replaced by other more or less equivalent funding sources. Unless a time comes when the GOP retakes control of both the Presidency and Congress, given their total absence of any commitment to fiscal responsibility.
6) "This program will not reduce the rate of growth in medical costs by anything like 1.5% a year." I'll bet that by 2020, it reduces the rate of growth by at least a percentage point.
7) "A fiscal crisis of some sort is quite likely by 2030, though not just
because of this program. But this program will make it worse..." Any fiscal crisis by 2020 will not have been made worse by this program. And as of 2020, the evidence will be strongly in favor of this law's having improved the outlook for the following decade.
8) "By 2030, there's an 80% chance that the government will have imposed
substantial price controls on pharma and other medical technology--and
this will noticeably slow the rate of innovation." This bill won't noticeably slow the rate of innovation by 2020, nor will anyone in 2020 be talking about a likelihood that it will do so anytime soon.
Now that I've met her challenge, I've got one in return:
Given that she led off that same post with the statement that "I think you people just screwed up both our health care system, and our
fiscal system (even further), and that if I'm right, that's not really
funny," I challenge her to back that assessment up with facts and argument, rather than expecting us to take her opinion seriously simply because she shared it with us. What reasons does she have for expecting any such things?
C'mon, Megan: turnabout is fair play. Back that shit up.
I wouldn't wait for a reply from McCardle. McCardle's arguments on every aspect of the progressive agenda remind me of those of a paid expert witness in a civil case or like those of the paid scientists that the tobacco companies used for years to challenge evidence on cigarette smoking. Empirical evidence is cherrypicked and leads to sweeping conclusions unsupported by a comprehensive review of facts. Worst case scenarios are played up when they support her contentions regarding the progressive agenda. Best case scenarios are presented as if they are the only possible conclusion when the contrary is true.
However, the worst part of her opinions writing is that she relies primarily on evidence based arguments of market failure for subsidies and government aid to her preferred interest groups (e.g. the finance industry, big banks), but retreats into her libertarian fantasy view of the world when it comes to government aid or protection from the whims of the market for anybody else.
The sad thing is she isn't being paid expert witness style fees to spout this nonsense.
Posted by: Joe | March 24, 2010 at 03:32 PM
McArdle is really such an astonishing twit. She knows absolutely nothing of the world and yet somehow has convinced the people at the Atlantic that she has something worthwhile to say. She is a callow Randist (a tautology I know) who lacks wisdom, life experience, or expertise in anything.
More wingnut affirmative action. If she were a liberal, she'd be xeroxing for someone.
Posted by: Sir Charles | March 24, 2010 at 04:27 PM
I have to disagree with you Sir C. Randists are truly horrible-- as Ayn Rand was a truly horrible person with a truly horrible worldview who espoused a truly horrible ethos and political philosophy. But Randists are at least consistent-- to the point of acting like they belong to some kind of robotic, sociopathic religion. Society must be structured around a totally free market-- consequences be damned. That's the only way for the truly competent to create.
But when it came to bailing out the financial system, McCardle was amazingly sympathetic. She found amazing nuance associated with those concerned about market failures.
On the other hand, McCardle's Randist arguments are selectively reserved for progressive constituencies and progressive initiatives.
Posted by: Joe | March 24, 2010 at 04:38 PM
McCardle used to blog as Jane Galt. Therefore it is perfectly fine to tar and feather her with all the worst aspects of Objectivism, because at this point it's just throwing feathers at someone who jump in Le Brea.
And I think that fact that McCardle reserves her Randist arguments only for liberal ideas just makes her more worst. So it's ok for nuance when we are throwing money at rich people, oh, but stopping mass death and bankruptcy and human suffering, well, that just goes against her principles?! Fuck her.
I should point out I didn't read all of this point. The is really too much writing aimed at engaging her ideas.
I come only to bash Randianism.
Posted by: Corvus9 | March 24, 2010 at 05:55 PM
First, I agree in part with Joe, but the percentage of Randists who are totally consistent in their beliefs is no larger than in any other faith-based system. Even the Texas Doctor who named his son Rand 'strays from the strict doctrine' occasionally -- as in his pro-forced pregnancy position. (And if said son wins the Kentucky Senatorial nomination, that might be one of the most important races to contribute too. McConnell's unanimous consent stunt is simple petulance, but imagine someone blocking almost all legislation on principle. Unanimous consent is a minor factor in the House, so Daddy is just an annoyance. But the Senate runs on unanimous consent, and Sonny Boy really could 'kill the Senate.' (In fact, this would mean the first six months of the next Congress would be tied up in finding a majority for rewriting the rules, but still...)
Later for the second part. Shoping pulls me away.
Posted by: Prup (aka Jim Benton) | March 24, 2010 at 06:04 PM
JOe,
Your point is well taken. She's an inconstant Randist. And a fucking twit.
Posted by: Sir Charles | March 24, 2010 at 06:08 PM
The term is "Randroid". As in, "There's a new shipment of Randroids coming off the line at 3:30. Prepare the gulching packs!"
Posted by: Mandos | March 24, 2010 at 06:40 PM
The second point is that while McCardle is a twit, she's pretty damn good at setting up sucker bets, and she set a good one here. The point is that every single one of the points she mentioned will be affected by any number of unforseeable factors, and both of you can write your comments claiming you 'won' right now, and 'fill in the blanks later.
Sir C: here's your start off: "In 2010, Megan and I had a challenge that would be settled today, On each of these, here is the results as of today. And while some argument can be made that the changes in X were caused by Factors A, and B, that the failure to reach the result in Y was a result of Factor C, and the higher than predicted change in Z comes from Factor D, in fact it is obvious that, once you discount for these, there are unremovable differences that totally match the predictions."
Megan, your turn: "Sir Charles is obviously deluded in thinking that you can not explain every change by other changes in the situation, and that none of the effects of HCR that were predicted actually occurred."
There will be unexpected medical breakthroughs, political changes -- the bill we are discussing might be totally superceded by a better one if the Republicans implode, if they regain control of even one branch of Congress, they could screw up the economy so badly that the effects will be hidden in the overall collapse. There are any number of unpredictable X Factors, technological, a new terrorist attack, either a 9/11 or an Oklahoma City, even some religious effect -- us atheists would be wiahing for a God we could ask to help us if the New Apostolic Rformation actually got some power. And the two of you will always be able to argue how much these xplain the changes that will take place.
Posted by: Prup (aka Jim Benton) | March 24, 2010 at 07:09 PM
And irrelevant, but I had to mention it. Guess which dentist has filed suit claiming that HCR violates her "right" to practice dentistry.
Posted by: Prup (aka Jim Benton) | March 24, 2010 at 07:16 PM
And irrelevant, but I had to mention it.
I already did...... ;)
Posted by: oddjob | March 24, 2010 at 08:38 PM
Have you ever seen Lady Gaga and Orly Taitz in the same room?
I thought not.
Posted by: Sir Charles | March 24, 2010 at 09:12 PM
LOLOLOLOL!!!!!!!!!!!!!!!!!
Posted by: oddjob | March 24, 2010 at 09:39 PM
very informational... educative as well, i read and felt like reading over and over again....good job!
Posted by: Acai Optimum | March 24, 2010 at 09:46 PM
Spam alert ^^^
Posted by: Prup (aka Jim Benton) | March 24, 2010 at 10:10 PM
i wonder what sort of offspring on-line doctor and acai optimum would gift us with.
orly and gaga: a thread-winner from SC.
Posted by: big bad wolf | March 24, 2010 at 10:31 PM
Prup up thread-
Exactly so, these are in no sense testable predictions. At least not in the manner in which they are stated.
I think one could also make the case that this bill is so diffuse and diluted that it is likely only to slow the bleeding instead of stop it, let alone reverse it.
This is just a typical disingenuous strawman series of claims. What we can be sure of is that the insurance industry is already beavering away to find loop holes and workarounds they can use to circumvent the intent, and that they are also gearing up their massive lobby to seek out and identify those legislators who are "on the market" and can be readily bought.
While it is true it is a step forward, and perhaps a major step forward, it is a drop in the ocean overall.
Since my comments elicited no response on the prior thread by SC about hamburgers and Israel - the best hamburger to be had in NYC used to be from Chumleys, I don't know if they are back in business yet or not.
Posted by: Krubozumo Nyankoye | March 24, 2010 at 10:39 PM
KN,
Sorry my friend. I did not mean to leave you hanging.
Posted by: Sir Charles | March 25, 2010 at 08:43 PM
KN,
I had looked at your comment and thought it was one of those topics that wasn't succeptible to a brief reply, but a post. And the idea of doing a full blown Israel -U.S. post left me exhausted. Sorry to cop out, but I feel like getting into this topic requires a level of care with what is said that it is daunting.
I very rarely post about the Middle East for this reason.
And now that I've driven 480 miles today, attended two meetings, and consumed 88 ounces of coffee -- now I'm consuming alcohol to bring myself back down -- I find the idea of such a post doubly unappealing. I promise I will address it in the future.
Posted by: Sir Charles | March 25, 2010 at 08:56 PM
SC - no problem, I fully understand we all do have lives outside this little text box input thingy.
If you would like I could provide you with something of a background on my viewpoint of the recent history of Liberia. It is not necessarily relevant to the middle east per se but there are stome striking parallels.
88 ounces? You may need to start looking for kidney donors. :-)
Posted by: Krubozumo Nyankoye | March 25, 2010 at 10:33 PM