The Optics of “Public Plan”

The new explanation for the mounting resistance to Democratic health care proposals is that people are confused, they don’t know what we’re getting into, and they prefer the devil they know. I think all that is true. But you have to follow up: why are people confused?

Obviously part of the problem is that they are being deliberately lied to. But there are probably relatively few people out there swallowing and regurgitating all the lies.

Why? Simple: relatively few people pay much attention to politics, and most people have a very low level of familiarity with the specifics of any particular issue. According to a recent Kaiser poll, only 27% of Americans are following the health care reform debate closely. There are strong believers on both sides of the issue, but the key, as it always is in American politics, is the mushy, ill-informed middle. Read the rest of this entry »

A Simple Preventive Measure: Provide Nutrition Facts

With all the hullabaloo surrounding the public option, it’s easy to overlook some of the other interesting features of potential health care reform. For instance, what exactly are these “preventive measures” that senators and pundits always talk about in the abstract, but about which we never seem to hear details?

This morning I haphazardly discovered one such measure, thanks mostly to Matt Lauer. This morning, as I ate my fiber-rich cereal topped with banana, blueberries, and skim milk (my personal preventive measure), I watched Matt do a feature on making smart choices in chain restaurants. He lined up five or six ungodly sandwiches from places like Chili’s and Ruby Tuesday, next to each of which was a slightly-less-ungodly alternative, invariably a pallid-looking grilled-chicken concoction. The placards displaying nutritional information (e.g., 1,900 calories for a burger topped with onion rings from Outback) were not even the most powerful reminder of the unhealthiness of much restaurant fare. That would be the mammoth bowls of French fries or plates of glazed donuts that were said to have equivalent amounts of sodium, or saturated fat, or cholesterol as their respective ungodly counterparts.

Watching this, I thought to myself, surely there are millions of people who would eat a huge gooey burger topped with blue cheese, knowing obliquely that it is “bad for you,” but who wouldn’t eat 17 orders of fast-food French fries if they knew that’s what they were effectively doing. And surely, if we got people to stop doing the former, we could cut down on obesity, diabetes, heart disease… and huge medical bills to treat those conditions.

But how to make people face these alimentary choices directly, with full (or, in econo-speak, “perfect”) information? Obviously one way is simply to require that restaurants disclose nutritional information in easy-to-read places, preferably right on their menus or big menu boards. “Texas Ranch Bacon Cheeseburger” (or whatever)  doesn’t sound quite so appetizing when you see “1,440 calories” and “1,800 mg sodium” next to it. New York City has the most famous such law, requiring eateries with more than 15 locations nationwide to post calorie counts on their menus. Philadelphia recently passed a stronger law, requiring disclosure of not just calorie counts but saturated fat, trans fat, sodium, and carbohydrates on printed menus (just calories on the big boards in fast-food restaurants). California is the only state with a nutrition-disclosure law.

Though perhaps not as controversial as a ban on trans fats like NYC’s, which impinges more obviously on Americans’ beloved freedom to make terrible, costly choices, a nationwide nutrition-disclosure requirement seems to me like one of those good ideas that might die a quick, quiet death in that graveyard of good ideas, the United States Senate. Various food-industry groups and fast-food company spokespeople will adopt the comfortable rhetoric of choice in order to defend denying people the information necessary to make choices. They may even evoke the “free market” in defense of information asymmetry, which, as economists know, always leads to a distortion of what consumers’ choices would look like in a real, pure market. These objections, of course, are and will be ridiculous. Nobody thinks the “free market” is harmed by my knowing that a serving of cereal contains 13 grams of sugar, or that a can of Dr. Pepper contains 40. Why it should be any different for food served in restaurants is beyond me.

In any case, the Senate HELP Committee health care reform proposal includes a calorie-disclosure requirement. It’s not perfect: I would like to see a national regulation modeled off Philadelphia’s, because calorie counts are only part of the nutritional picture. And I think that, in an ideal world, the regulation would apply to all restaurants, not just chain ones. I can see why the issue is tackled that way: for one thing, fast food and chain restaurants attract poorer clientele, who are more likely to be insufficiently educated about proper nutrition; for another, they are easier to demonize because everybody, even those who frequent such places, knows that they’re bad for you. But there’s no reason other than political calculation to exempt a 16-ounce Wagyu steak from a law covering a Texas Ranch Bacon Cheeseburger.

So, let’s hope that the HELP Committee’s proposal, which is a good start, does not die in the markup process, and that it is incorporated, if it’s not already, into other health care reform proposals. I’ll eat to that.

Get Real Re: Rationing

The Republican fear-mongering about health care “rationing” does not stand up to reasonable scrutiny, such as that provided here by David Leonhardt of the NY Times. All societies must make distributive choices, and it is sheer utopian fantasy to think we could ever provide everyone with all the health care they want, or even need.

Another, related issue that doesn’t get enough attention is that the GOP’s antipathy towards rationing  would seem to protect inefficient, unhelpful health care. You would think “rationing” could only be bad if the item being rationed were, you know, good, but the Republicans don’t even like the idea of assembling data and best-practices information and making them available to doctors. If a certain procedure or treatment works well, it won’t be “rationed” by such harmless regulations. So the Republicans are essentially defending the sacred right of doctors to be wrong.

Another interesting , oft-overlooked irony is the fact that the last time the Republican Party had a health care plan of its own, “rationing” was a quite explicit goal of theirs. What do you think Sen. McCain meant when he talked about consumers taking “individual responsibility,” and becoming “much more responsible in health care costs”? The goal of his health care plan was to force consumers to put more skin in the game by exposing them directly to the costs of health insurance, giving them insufficient funds with which to purchase it, and forcing down insurance costs using the bluntest instrument possible, the consumers’ inability to purchase adequate coverage. You might say the consumer would be doing the rationing rather than the government, but that is not the reality of it: the quality of health insurance would be determined by the seemingly arbitrary amount of the government’s tax credit.

It would be useful to remember such things when dealing with demagogues like Mark Steyn who suggest that President Obama is going to lower costs by euthanizing old people. The claim is not just crass, offensive, and blind to the unavoidable hard choices of policy making, but shockingly lacking in self-awareness to boot.