The White House's laughably bad attack on Medicare-for-all

Your faithful correspondent made an appearance in a White House Council of Economic Advisers (CEA) report on Tuesday. If it weren't the Trump administration, I would have been gobsmacked at this development, as well as the incredible amateurishness of the product. But because it is the Trump administration, I'm mildly impressed that they spelled my name correctly.

The report is titled "The Opportunity Costs of Socialism," and it reads like it was written by the guy who wrote the Dow: 36,000 book published right before the dot-com stock market crash — oh wait, turns out the co-author is now chair of the CEA. What fun times we live in.

In between agitprop about Venezuela and some truly ridiculous economics, the report spends a lot of time trying to prove Medicare-for-all is bad, which is where it cites one of my previous articles. (Perhaps they were inspired by new polling that shows a majority of Republicans now support the policy.) Unsurprisingly, the case is total garbage.

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One prong of the argument is the typical conservative circular reasoning about markets. Medicare-for-all will remove choices, and thereby reduce freedom: "A consumer who is unhappy with the state’s choices has little recourse," the authors write. The logic here is that because markets (supposedly) operate through consumers choosing between different providers, they increase freedom, which can be seen because customers get to choose. But this is just to say markets increase freedom because they increase freedom.

Fallacies aside, the assumption here is that choice is what we want. But is it? If health care is delivered through market institutions, I am forced to make complicated, burdensome decisions I am unqualified to make about insurance options and other matters. Should I pick a higher deductible and hope I don't get sick, or a lower one and chance paying a lot for coverage I don't use? Then I must pay very close attention to doctor networks, covered prescription drugs, and so on.

Then if I ever have to actually get treated, I have to become an amateur claims adjuster and medical regulation policy specialist, because of the strong possibility either the insurance company or the provider (or both) will try to rip me off to the tune of tens or hundreds of thousands of dollars. And if I just have a random emergency and end up in an out-of-network hospital, chances are my life savings are going into some health-care executive's third Maserati.

Speaking personally, I hate doing this stuff. I would gladly pay considerably more in taxes to get simple, universal coverage that I knew was always there when I needed it — indeed, it would be cause for delirious celebration, because I would be free of all that headache and worry. I (or anyone else) could go back to school, or start a new business, or take to the road as an itinerant nature writer, secure in the knowledge that if I got sick, I would still be able to receive care. A universal system would thus be tremendously freedom-enhancing.

A second prong in the CEA report has to do with wait times, and it straightforwardly makes the case for Medicare-for-all while pretending otherwise. I am not exaggerating even slightly. Here is the chart.

(CEA)

The takeaway here is supposed to be that America's free-market system keeps wait times low for seniors. The problem is that almost all Americans over 65 are on Medicare, the very single-payer system the report is supposedly disproving. Sarah Kliff digs into more minor distortions here, but this is about as nakedly a case of up-is-down lying one could possibly imagine.

Another major prong is about money. They include the following high school-level illustration of economic incentives:

(CEA)

The idea is that "[i]ndividuals also have little reason to economize on anything that they can obtain without payment," implying that medical spending will shoot through the roof under Medicare-for-all. The very obvious problem with this hypothesis is that America already has a fairly private market-based health-care system, and we have the most expensive health care in the world by a huge margin.

As I carefully explained in the article cited by the CEA, America's ramshackle health-care system is simply wasting that money. We don't get to see the doctor more, and our health-care outcomes range from mediocre to abysmal. Every year we flush a trillion bucks straight down a toilet of price-gouging, pointless complexity, and straight-up fraud.

There is some more stuff about Medicare-for-all torpedoing the American economy to the tune of eleventy bazillion dollars, but the various theoretical rationales are so preposterous they aren't worth getting into. If this is the best attack on Medicare-for-all American conservatives can come up with, we may safely conclude the policy debate is settled.