Showing posts with label Arent. Show all posts
Showing posts with label Arent. Show all posts

Friday, June 21, 2013

ObamaCare's Free Preventive Services Aren't Free

Credit: National Institutes of Health Library / Foter.com / CC BY-NC-SACredit: National Institutes of Health Library / Foter.com / CC BY-NC-SA

As public support for ObamaCare slumps into a post-election decline, the Department of Health and Human Services is trying to convince people that they ought to like the law by noting that it’s already given free stuff to a whole bunch of people. An HHS news release this week brags that the “Affordable Care Act extended free preventive care to 71 million Americans with private health insurance” as well as 34 million Medicare Advantage beneficiaries—free benefits the agency says are giving Americans “more value” for their health dollars.

The problem is that the benefits in question are neither “free” nor likely to produce valuable savings. ObamaCare’s rules eliminated individual cost-sharing for a number of preventive services, but, as the administration admitted a few months after the law passed, at the cost of higher insurance premiums on average. It’s like a gym that suddenly makes all the drinks and snacks at its café “free”—but raises the price of membership. It’s not free. You’re just paying in a different way.

It’s not cost-saving as public policy either, despite initial Democratic hopes that it would be. In fact, most evidence shows that it increases health spending. That’s because eliminating cost-sharing increases utilization of preventive services; when there’s no immediate price to pay for using a service, people tend to use more of it. And as the Congressional Budget Office reported back in 2009, “the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall." In general, the CBO noted, researchers have found that “the added costs of widespread use of preventive services tend to exceed the savings from averted illness.”

For preventive services to have the largest benefits relative to costs, the CBO explained, the prevention efforts need to be narrowly targeted at only a few people who are likely to develop a particular ailment. The HHS claim that 105 million people took advantage of ObamaCare’s “free” services suggests that there was not much targeting involved. Instead, the law took a broad-brush approach that likely raised insurance premiums for many and perhaps most of the individuals affected. But I suppose “Affordable Care Act shifts costs and raises premiums for 71 million Americans with private health insurance” doesn’t make quite as good a press release.


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Thursday, May 23, 2013

The Good News About Human Nature: Most People Aren’t Jerks

She was wrong.

A broad breakdown in societal trust has undermined the idea of a common good that can be served by the collective disposition of resources. Voters trust neither government nor most individuals in society to fairly pursue the common good. Instead, they see both government and individuals as fundamentally selfish and out for themselves, not others.

This view of human nature has been a consensus until recently. That consensus can be traced back to the 1957 publication of Atlas Shrugged by Ayn Rand, a 1,200 novel that, in essence, advocated the unfettered pursuit of self-interest as the organizing principle for society. Despite the fact that the book became a best-seller, not many critics and intellectuals took it or its thesis seriously at the time. Who could possibly believe that a society based strictly on selfishness could work?

That skepticism was obliterated in the next several decades. One of the key blows was struck by evolutionary biologist Richard Dawkins, whose 1976 book, The Selfish Gene, argued that the gene is the fundamental unit of natural selection and has only one imperative: successfully reproducing itself in competition with other genes. We (and other animals), as bearers of these “selfish” genes, will therefore carry those traits — and only those traits –that help these genes reproduce. Dawkins implied that was all you needed to know to understand human nature, an idea that quickly led to an explosion of selfish gene-based explanations for every aspect of human behavior.

Then, in 1980, Milton Friedman, with his wife, Rose, published Free to Choose, a no-holds-barred polemic in favor of self-interested individuals making “rational”, unregulated decisions and against anything that interfered with this process, especially government action. So, in a powerful conjunction of economics and evolutionary biology, Ayn Rand’s glorification of selfishness gained the imprimatur of serious science. Being selfish was just human nature and should not be fought. Indeed, any attempt to do so was bound to do more harm than good. Thus was the original reaction to Atlas Shrugged turned on its head. Who could possibly believe that a society based on anything other than selfishness could work?

No doubt Ayn Rand would have been delighted with the progress of her big idea in the subsequent decade. Ronald Reagan was elected US president and Margaret Thatcher became Prime Minister of the UK, both practicing a politics best summarized as “government is the problem, not the solution” and both preaching an economic gospel that glorified the individual pursuit of wealth above all else. And her disciple, Alan Greenspan, was appointed head of the Federal Reserve in 1987 and remained there for 19 years, treated reverentially by both Democratic and Republican administrations.

Also in the 1980s, the breakdown of the postwar welfare states became undeniable and, by, the end of the decade, the Soviet Union and other “socialist” countries had ignominiously collapsed. Conservatives argued that all this was real world confirmation of Rand’s core idea: those who interfered with human selfishness would reap the whirlwind.

But right at its moment of greatest success, the conservative case on human nature was being fatally undermined. New thinking and research in evolutionary science showed that the “selfishness is all” camp was completely missing the mark on what makes humanity distinctive. It is not competition for individual reproductive success but rather cooperation for group reproductive success, facilitated by our capacities for symbolic thought (language) and transmission of learned information (culture), that has led to our success as a species.

In short, the key to understanding human nature is not the selfish gene, bur rather the “selfless gene”. The selfless gene allowed our ancestors to think and act as a group, thereby outcompeting other chimp-like species—literally leaving them in the dust. Moreover, our cooperative nature allowed us to build ever more complex ways of interacting with one another, which led to further evolution in the traits that facilitate cooperation (referred to as “gene-culture coevolution”). The end result of this dynamic was civilization and, eventually, the global interconnected society we live in today.

This is who we are. We are defined by our sense of fairness, adherence to group norms, willingness to punish those who violate such norms, willingness to share, and willingness to work for the good of the group, along with the high-level cognitive and cultural traits that enable us to be that way. We are not a species of seven billion selfish individuals, uninterested in anything save our own welfare and willing to cheerfully break any rule and hurt any other individual to secure it. Indeed, we think of such people as sociopaths and if their tendencies actually dominated humanity we would still be back on the savannah with the rest of the chimp-like species.

So the former consensus view on human nature is just plain wrong. It’s not the case that societies must rely exclusively on self-interest or die. In fact, societies have only prospered by transcending self-interest and harnessing the group-oriented instincts that make us human. As E.O. Wilson puts it in his new book, The Social Conquest of Earth, “At the higher level of….biological organization, groups compete with groups, favoring cooperative social traits among members of the same group. At the lower level, members of the same group compete with one another in a manner that leads to self-serving behavior. The opposition between the two levels of natural selection has resulted in a chimeric genotype in each person. It renders each of us part saint and part sinner.” (p. 289)

This makes clear that the center-left can only be successful if it sells its program as one that binds people together as a group, with attendant benefits and responsibilities. Otherwise, the “sinner” side of people will dominate over the “saint” side, reinforcing current levels of distrust and encouraging people to simply look out for themselves. Therefore, instead of shying away from appeals to cooperative instincts and the common good as somehow soft-headed, progressives should think of such appeals as the most realistic, theoretically sound way of building support for their initiatives. This is the profound implication of the new theory of human nature.


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Thursday, January 24, 2013

Three Things The NRA Wants You To Believe About Biden’s Gun Safety Task Force That Aren’t True

On Thursday, the National Rifle Association (NRA) blasted the Obama administration for undermining Americans’ Second Amendment rights just moments after its representatives met with Vice President Joe Biden and the White House task force to reduce gun violence.

Two years ago, the NRA wouldn’t even meet with President Obama and the group’s CEO and executive vice president Wayne LaPierre warned that he would confiscate “our firearms” and undermine America’s greatness. In a statement following Thursday’s meeting, the group demonstrated that it’s still not interested in reducing gun crimes, offering three misleading claims about its intentions:

1. The NRA was “prepared to have a meaningful conversation.” The NRA claimed that it’s willing to consider “school safety, mental health issues, the marketing of violence to our kids and the collapse of federal prosecutions of violent criminals.” The glaring omission in that list is any action involves the sale of guns and ammunition. It’s the same tactic they tried in their widely-panned press conference where they went so far as to blame hurricanes, but not guns. The resistance to any gun violence prevention measures that involve actual firearms shows that the NRA really wasn’t interested in a “meaningful conversation” where all options were on the table.

2. The White House has “an agenda to attack the Second Amendment.” Despite LaPierre’s paranoid insistence that the White House was lulling gun owners into a false sense of security by not passing any gun laws during his first four years, the Obama administration actually expanded gun rights in its first four years by loosening restrictions for concealed carry on federal grounds. Both Biden and Obama have insisted that they have no intention of changing the right to bear arms — rather, they simply want to create restrictions that make it harder for murderers to acquire their weapon of choice.

3. The “Administration continues to insist on pushing failed solutions.” There’s really no proof that universal background checks, restrictions on military-style assault weapons and high-capacity magazines, and expanded mental health services are “failed solutions.” In fact, evidence points to the opposite: Since the repeal of the assault weapons ban, mass shootings have drastically increased and studies show that the firepower of gunmen (how many rounds they shoot, and how quickly they shoot them) has jumped significantly.

Biden plans to deliver his suggestions for possible gun violence prevention laws to Obama on Tuesday. On Friday, he will meet with the entertainment and television industries. It’s likely that will be a more positive meeting, since representatives have signalled they will be more receptive to Biden’s case. In a statement, they wrote, “We welcome the opportunity to share that history and look forward to doing our part to seek meaningful solutions.” That’s despite that videogames and movies, unlike guns, can’t kill people.


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