There are a number of people, primarily on the Right, who think of the UN as worse than useless and actually harmful to the US. “Imperfect” doesn’t begin to describe the UN, but decades of US foreign policy under both parties can’t be completely wrong. Hopefully. Maybe looking at the pros and cons of the US-UN relationship will shed some light on the matter.
CON: The UN is irrelevant
To get an idea why the United Nations has difficulty being relevant, imagine trying to get 192 nations to agree on anything. This is an oversimplification of course, but it gets at one of the main impediments to effective UN actions. It takes a majority of those nations to form a resolution in the General Assembly. Consider that only 89 of them are rated as politically free or only 83 of them are rated as even moderately economically free, and one begins to understand why the General Assembly isn’t exactly the beacon of humanity that it’s made out to be.
To do anything really substantial, the Security Council needs to be involved. This requires the unanimous consent of China, France, Russia, the United Kingdom, and the United States. Getting these countries to agree on the color of an orange would be a challenge.
PRO: The UN is occasionally relevant
There are some things on which the vast majority of people can agree, such as refugees should be sheltered. The UN operates a number of agencies that are, in effect, global charities.
CON: The UN is toothless
Then there are things on which the not-so-free majority of countries can agree, such as covering for each other when a minority gets oppressed or a democratic movement gets crushed. While the UN may be of minimal utility as an observer in international conflicts, it is astonishingly inept when dealing with human rights issues within a country’s borders (Somalia, Sudan, Yugoslavia, etc.).
PRO: The UN is toothless
If the UN was capable of operating as an armed world government, it would not suffer the presence of a national superpower like the US or, someday, China. Since the UN Security Council is composed of the victors of World War II (and France), they are the ones who would have the most to lose from switching the UN from a confederacy to a federation. This switch could never happen without the Security Council’s consent, so the UN’s toothlessness is assured for the foreseeable future.
CON: Enemies of the US have bases of operation in New York City
The countries that have permanent missions to the UN have them in New York City, even if they don’t have diplomatic relations with the US. This gives these countries the ability to move non-official cover agents in and out of the US, not to mention diplomatic pouches filled with who-knows-what.
PRO: Enemies of the US need to keep their agents in New York City
While I’m not aware of the US ever opening a diplomatic pouch, all of the other tools of spycraft are available to watch over the people working at these UN missions. It’s not that an Iranian secretary is going to accidentally drop a map of nuclear sites; it’s that the CIA can gather all of the dirty laundry on the people who do the negotiating at the UN. Having an envelope full of the proverbial blackmail photos can help the US (or its allies) get an edge in day-to-day international disputes.
The UN may have devolved into letting the inmates run the asylum, but it is a massive bureaucracy with many moving parts that the US government seems to think is worth greasing once in a while. Whether the pros really outweigh the cons, however, is an open question.
Monday, December 28, 2009
Sunday, December 6, 2009
The Climate Is Changing
The argument for pre-emptive measures to halt man-made global warming tends to go something like this: the planet Venus has surface temperatures hot enough to melt lead, this heat is maintained by a carbon dioxide (CO2) fueled runaway greenhouse effect, industrial activity on Earth increases atmospheric CO2, rising CO2 will raise Earth’s temperature via a greenhouse effect, therefore industrial activity must be curtailed to save the Earth. If you sensed that some important details were missing from that argument, you are correct. Venus’s atmosphere has about 230,000 times as much CO2 as Earth’s. In fact, there is an order of magnitude more carbon in Venus’s atmosphere than there is in all of the atmosphere, oceans and crust of the Earth. There is also some evidence that Venus’s oceans boiled away first, then the CO2 built up to ridiculous levels.
The problem with the climate change argument is not so much a tendency for stretched analogies, but rather a problem with the predictive power of climate models. The Intergovernmental Panel on Climate Change (IPCC) uses very complex models to predict what will happen to the Earth’s climate when certain things change. These models do a good job of explaining the past, but never seem to anticipate what happens next. Sounds like a strange problem for a model to have, but “overfitting” is actually a well-known problem in statistics.
Whenever there is a cool summer or other evidence that the Earth is not about to burst into flame, mainstream climate researchers come out after the fact and explain that this or that happened, but don’t worry because the planet will get back to baking in short order. Inconvenient facts like decreasing temperatures since 1998 are dismissed. This is a shame, since as recently as the 1970s scientists were warning us of an impending ice age. If only the ice age doomsayers had held on for a couple more decades!
If the world is going to throw trillions of dollars at a problem because a model predicts doom, the world might demand a reasonable level of performance from that model. The world might also want to know why natural sources led to wild fluctuation of Earth’s climate in the past but that any change today must be of artificial origin (the simplest explanation is that the dinosaurs were using SUVs and coal-fired power plants).
Note that decreasing temperatures since 1998 do not mean global warming is not happening. All sides agree that Earth’s climate is full of complex feedback mechanisms, and the planet could just be shifting gears on an upward trajectory. However, since the last ten years caught mainstream climatologists by surprise, and a natural explanation is at hand (a particularly calm sunspot cycle), it would be prudent to make sure that a multi-trillion dollar effort won’t be made moot by some random blip in natural variation.
There are a number of environmental problems that need to be addressed even if global warming turns out be a complete fabrication. The problem is that environmentalists have put all of their stock in one boogeyman called CO2. CO2 became too important, and economic interests in continuing the gravy train of government funding appear to have led some researchers to proclaim that global warming is a threat no matter what the evidence says.
Since cuts to space programs mean we won’t have another planet to live on for quite some time, it makes sense to take care of the one we’re on. However, the solution is not to have government regulate the economy to death. For example, classifying CO2 as a pollutant would mean any business with a carbon footprint over 250 tons per year would have to install fantastically expensive mitigation technologies. (Yes, the EPA says its regulations only target those over 25,000 tons per year but the law says 250 tons of any pollutant gets you on the list, and the EPA doesn’t have the authority to change that number.) There are about 6.1 million such “polluters” in the country. Making them install useless carbon control technology is just the kind of job-killing move that the economy needs right now.
The solution to this problem is to let someone make money from solving bits of it. A cap-and-trade scheme is helpful when it deals with actual pollutants rather than a natural component of the atmosphere. Furthermore, businesses that sell mitigation technologies should be incentivized to work with developing nations rather than lobbying Western leaders for a captive customer base in the developed world.
One additional course correction is to make sure that the money from solving the problem actually goes to those trying to solve the problem as opposed to fearmongers who benefit financially from continued panic no matter the actual facts.
The problem with the climate change argument is not so much a tendency for stretched analogies, but rather a problem with the predictive power of climate models. The Intergovernmental Panel on Climate Change (IPCC) uses very complex models to predict what will happen to the Earth’s climate when certain things change. These models do a good job of explaining the past, but never seem to anticipate what happens next. Sounds like a strange problem for a model to have, but “overfitting” is actually a well-known problem in statistics.
Whenever there is a cool summer or other evidence that the Earth is not about to burst into flame, mainstream climate researchers come out after the fact and explain that this or that happened, but don’t worry because the planet will get back to baking in short order. Inconvenient facts like decreasing temperatures since 1998 are dismissed. This is a shame, since as recently as the 1970s scientists were warning us of an impending ice age. If only the ice age doomsayers had held on for a couple more decades!
If the world is going to throw trillions of dollars at a problem because a model predicts doom, the world might demand a reasonable level of performance from that model. The world might also want to know why natural sources led to wild fluctuation of Earth’s climate in the past but that any change today must be of artificial origin (the simplest explanation is that the dinosaurs were using SUVs and coal-fired power plants).
Note that decreasing temperatures since 1998 do not mean global warming is not happening. All sides agree that Earth’s climate is full of complex feedback mechanisms, and the planet could just be shifting gears on an upward trajectory. However, since the last ten years caught mainstream climatologists by surprise, and a natural explanation is at hand (a particularly calm sunspot cycle), it would be prudent to make sure that a multi-trillion dollar effort won’t be made moot by some random blip in natural variation.
There are a number of environmental problems that need to be addressed even if global warming turns out be a complete fabrication. The problem is that environmentalists have put all of their stock in one boogeyman called CO2. CO2 became too important, and economic interests in continuing the gravy train of government funding appear to have led some researchers to proclaim that global warming is a threat no matter what the evidence says.
Since cuts to space programs mean we won’t have another planet to live on for quite some time, it makes sense to take care of the one we’re on. However, the solution is not to have government regulate the economy to death. For example, classifying CO2 as a pollutant would mean any business with a carbon footprint over 250 tons per year would have to install fantastically expensive mitigation technologies. (Yes, the EPA says its regulations only target those over 25,000 tons per year but the law says 250 tons of any pollutant gets you on the list, and the EPA doesn’t have the authority to change that number.) There are about 6.1 million such “polluters” in the country. Making them install useless carbon control technology is just the kind of job-killing move that the economy needs right now.
The solution to this problem is to let someone make money from solving bits of it. A cap-and-trade scheme is helpful when it deals with actual pollutants rather than a natural component of the atmosphere. Furthermore, businesses that sell mitigation technologies should be incentivized to work with developing nations rather than lobbying Western leaders for a captive customer base in the developed world.
One additional course correction is to make sure that the money from solving the problem actually goes to those trying to solve the problem as opposed to fearmongers who benefit financially from continued panic no matter the actual facts.
Thursday, December 3, 2009
Life, Liberty, and the Pursuit of Mandates, Part 2
Even if one believes that the private health care system is flawed for the majority, the proper course of action is to decrease distortions of the market then weave a safety net underneath. In any market that private enterprise can participate in, private enterprise is the more efficient route. Government's idea of cost-cutting is to pay less and demand the same results. In some cases this works (defense contracts have quite a bit of padding on them). In cases like health care, the options are to wring fraud out of the system (which governments are spectacularly inept at doing) or pay below-market rates.
The health care industry has responded to past unfunded mandates by simply refusing to provide the service, for example all of the Emergency Room closures in California. The income prospects (net of liability insurance) in some specialties have led to dwindling numbers of doctors entering them, which will lead to de facto rationing if the government lowers its payments any further. If the government starts dictating specialties to new doctors, it will end up getting lower quality doctors and picking up the tab for liability insurance. Then all those medical malpractice judgments will be paid by taxpayers. The jurors in those cases are taxpayers. This would not be a welcome turn of events for the trial lawyers currently supporting the health reform initiative.
A government-run health plan that muscles out private insurance (the stated goal of many health reform advocates) would operate under incredible constraints, with obligations added or subtracted by the courts pretty much at random. Many backing the current reform effort are Pro-Choice and would be annoyed to discover that a government-run health plan would be banned from covering elective abortions. The idea of collecting a separate premium for this coverage will not work: either the premium is paid to the government (which makes it government funds) or it is paid through an employer who now knows if the person has elected to enroll in this particular coverage or not (a very serious loss of privacy).
A 60-vote majority in the Senate is a rare opportunity for a party to put a stamp on how government operates. A number of Democratic leaders have made statements to the effect that they want some kind, any kind, of government plan in place, and that they will fix the details later. Economic interests adapt to government mandates very quickly (note how credit card companies hiked everyone's rate before the new anti-rate-hiking rules took effect), and even common-sense reforms become difficult.
There are a few smaller reforms that would enjoy broad public and bipartisan support and accomplish the goals of increasing access and decreasing costs:
1. There is no compelling reason to tie health insurance to one's job. Untying these (by expanding the current employer health insurance tax break to include individual policies, or giving everyone a blanket tax exemption for health care costs) would relieve a lot of the consumer-is-not-the-customer problems plaguing health care. It would make the labor market more efficient, since people would not be staying in bad jobs just for fear of losing health insurance.
2. Allowing people to buy health insurance across state lines would introduce a lot more competition than adding a single government insurance plan. Such policies would fall squarely under the federal jurisdiction for interstate commerce, which is important since regulators would need to prevent the massive consolidation that otherwise would occur among insurance companies. Congress can tack on any coverage requirements that it wants, and individuals can “opt out” by buying an in-state plan.
3. Identify the uninsured and target solutions to them rather than trying a one-size-fits-all reform that will end up fitting no one. A number of states have already piloted high-risk pools for those with pre-existing conditions. Allow someone to have this kind of high-risk insurance and a regular health plan until the exclusion period on the regular plan ends. Cost-cutting may bring some healthy or low-income people into the market. For those who still do not buy insurance, allow cheap catastrophic coverage that will prevent an unexpected illness from bankrupting the patient and/or sticking taxpayers with the bill.
Other reforms might meet significant resistance from one political camp or another, but should a special interest really be allowed to keep everyone else from enjoying a better system?
4. Everyone claims that wellness programs reduce medical costs. Whether this really pans out or not, the Medicare Advantage plans that include wellness are doing well enough to stay in business. Create a parallel Medicaid Advantage program and see if this really works.
5. Take some steps toward reigning in medical malpractice costs. The fear of gigantic judgments leads to defensive medicine and drives up costs. The specter of high malpractice insurance costs deters entrants to certain medical fields, too. Specialized medical courts would at least put some rationality into the system; we do this for traffic, foreign intelligence activities, taxes, patents, etc., so why not medicine? The existence of a predictable court system might even end the practice of getting patients to sign away their rights on those agree-to-arbitrate forms. It also seems to be a lot fairer than artificial caps on judgments.
6. Get hospital reimbursements in line with actual hospital expenditures. If the law requires hospitals to treat anyone who staggers into the Emergency Room, the law should provide a way to pay for it. The current practice is massive cost-shifting (such as high Medicare fees to make up for unreimbursed Emergency Room care). Some hospitals are better at managing cost shifts than others, and the ones that aren’t so good at it end up closing their Emergency Rooms to the detriment of the surrounding community. Also, better ties between service and payment will make fraud easier to spot.
The health care industry has responded to past unfunded mandates by simply refusing to provide the service, for example all of the Emergency Room closures in California. The income prospects (net of liability insurance) in some specialties have led to dwindling numbers of doctors entering them, which will lead to de facto rationing if the government lowers its payments any further. If the government starts dictating specialties to new doctors, it will end up getting lower quality doctors and picking up the tab for liability insurance. Then all those medical malpractice judgments will be paid by taxpayers. The jurors in those cases are taxpayers. This would not be a welcome turn of events for the trial lawyers currently supporting the health reform initiative.
A government-run health plan that muscles out private insurance (the stated goal of many health reform advocates) would operate under incredible constraints, with obligations added or subtracted by the courts pretty much at random. Many backing the current reform effort are Pro-Choice and would be annoyed to discover that a government-run health plan would be banned from covering elective abortions. The idea of collecting a separate premium for this coverage will not work: either the premium is paid to the government (which makes it government funds) or it is paid through an employer who now knows if the person has elected to enroll in this particular coverage or not (a very serious loss of privacy).
A 60-vote majority in the Senate is a rare opportunity for a party to put a stamp on how government operates. A number of Democratic leaders have made statements to the effect that they want some kind, any kind, of government plan in place, and that they will fix the details later. Economic interests adapt to government mandates very quickly (note how credit card companies hiked everyone's rate before the new anti-rate-hiking rules took effect), and even common-sense reforms become difficult.
There are a few smaller reforms that would enjoy broad public and bipartisan support and accomplish the goals of increasing access and decreasing costs:
1. There is no compelling reason to tie health insurance to one's job. Untying these (by expanding the current employer health insurance tax break to include individual policies, or giving everyone a blanket tax exemption for health care costs) would relieve a lot of the consumer-is-not-the-customer problems plaguing health care. It would make the labor market more efficient, since people would not be staying in bad jobs just for fear of losing health insurance.
2. Allowing people to buy health insurance across state lines would introduce a lot more competition than adding a single government insurance plan. Such policies would fall squarely under the federal jurisdiction for interstate commerce, which is important since regulators would need to prevent the massive consolidation that otherwise would occur among insurance companies. Congress can tack on any coverage requirements that it wants, and individuals can “opt out” by buying an in-state plan.
3. Identify the uninsured and target solutions to them rather than trying a one-size-fits-all reform that will end up fitting no one. A number of states have already piloted high-risk pools for those with pre-existing conditions. Allow someone to have this kind of high-risk insurance and a regular health plan until the exclusion period on the regular plan ends. Cost-cutting may bring some healthy or low-income people into the market. For those who still do not buy insurance, allow cheap catastrophic coverage that will prevent an unexpected illness from bankrupting the patient and/or sticking taxpayers with the bill.
Other reforms might meet significant resistance from one political camp or another, but should a special interest really be allowed to keep everyone else from enjoying a better system?
4. Everyone claims that wellness programs reduce medical costs. Whether this really pans out or not, the Medicare Advantage plans that include wellness are doing well enough to stay in business. Create a parallel Medicaid Advantage program and see if this really works.
5. Take some steps toward reigning in medical malpractice costs. The fear of gigantic judgments leads to defensive medicine and drives up costs. The specter of high malpractice insurance costs deters entrants to certain medical fields, too. Specialized medical courts would at least put some rationality into the system; we do this for traffic, foreign intelligence activities, taxes, patents, etc., so why not medicine? The existence of a predictable court system might even end the practice of getting patients to sign away their rights on those agree-to-arbitrate forms. It also seems to be a lot fairer than artificial caps on judgments.
6. Get hospital reimbursements in line with actual hospital expenditures. If the law requires hospitals to treat anyone who staggers into the Emergency Room, the law should provide a way to pay for it. The current practice is massive cost-shifting (such as high Medicare fees to make up for unreimbursed Emergency Room care). Some hospitals are better at managing cost shifts than others, and the ones that aren’t so good at it end up closing their Emergency Rooms to the detriment of the surrounding community. Also, better ties between service and payment will make fraud easier to spot.
Wednesday, December 2, 2009
Life, Liberty, and the Pursuit of Mandates, Part 1
The debate over health care reform has taken on sense of monumental importance for a number of reasons. The White House has basically put its prestige on the line, and this has created a political need to accomplish something called health care reform. Some have even decided to claim the moral high ground by claiming they are fighting for a human rights issue.
The first thing to understand is that there is no right to health care, although it is not difficult to imagine why one might believe there is.
The US's Declaration of Independence states, "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness." A reasonable level of health care is certainly a precondition for Life, and arguably for Liberty and Happiness as well.
The UN's Universal Declaration of Human Rights also declares, "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control." The US has considered the Declaration of Independence as a moral obligation since the time of President Abraham Lincoln, and the US is a signatory of the Universal Declaration of Human Rights. So the whole matter would appear to be settled.
Not so fast. There are other preconditions to Life, and some of these are mentioned in the UN declaration as well. Namely, Life depends on the availability to adequate food and shelter (there are those who argue if clothing is actually necessary). This means there is a human right to food, and this right is more fundamental than the right to health care (food can sustain Life without health care, but health care cannot sustain Life without food). How has this right to food been handled?
Estimates of the number differ, but there is consensus that millions of people in the US do not get enough to eat. The US also has plenty of food, so much so that many US farms receive subsidies to produce less than their full potential. Combine ample supplies of food, individuals' right to that food, and a breakdown somewhere getting the food to the right people; the only logical conclusion is that the government must step in to rectify this market failure. Indeed, the government has.
Did the federal government buy all of the food and distribute it to the people? Of course not. Government agencies and nonprofits have developed to serve specific populations. The market is functioning just fine for the vast majority of Americans, and the gaps are addressed with as little nonmarket allocation as possible so as to preserve that market. The system is imperfect, but no one is advocating a Universal Food Service approach.
The federal government has regulations mandating minimum standards for food, but this has little to do with delivering food to those who need it. Article I Section 8 of the US Constitution gives the government authority to regulate food, but only if it crosses state lines. Community gardens, farmers’ markets, local produce used in restaurants, etc. are all outside of federal jurisdiction (the idea that anything could be outside the federal government’s jurisdiction comes as a shock to many).
Programs to provide food to those in need exist alongside ("compete with") private enterprise, but the programs serve only those not served sufficiently by the regular market. A problem delivering health care to a segment of the population is similar; an underserved segment of the population is cause for targeted intervention, not cause to uproot the system with which the vast majority of Americans are quite happy.
When the government attempts to provide universal service in competition with private providers, a pattern always emerges. The government stacks the deck in the public entity's favor (e.g., the legally mandated minimum fees for couriers and delivery companies are higher than US Postal Service rates, the taxes collected to educate a child always go to a public school rather than follow the child to whatever school he/she actually attends), consumers show near-universal preference for the private version, and market distortions from stacking the deck put the private version economically out of reach of many who otherwise would choose that option.
The proper thing for these public entities to do is to contract in scope and provide only to those who need them, letting an efficient market handle the bulk of the population. Government bureaucracies don't do contraction very well, so the whole market suffers. Enacting an overbroad government health care plan would be extremely difficult to undo, so too little is definitely preferable to too much.
The first thing to understand is that there is no right to health care, although it is not difficult to imagine why one might believe there is.
The US's Declaration of Independence states, "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness." A reasonable level of health care is certainly a precondition for Life, and arguably for Liberty and Happiness as well.
The UN's Universal Declaration of Human Rights also declares, "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control." The US has considered the Declaration of Independence as a moral obligation since the time of President Abraham Lincoln, and the US is a signatory of the Universal Declaration of Human Rights. So the whole matter would appear to be settled.
Not so fast. There are other preconditions to Life, and some of these are mentioned in the UN declaration as well. Namely, Life depends on the availability to adequate food and shelter (there are those who argue if clothing is actually necessary). This means there is a human right to food, and this right is more fundamental than the right to health care (food can sustain Life without health care, but health care cannot sustain Life without food). How has this right to food been handled?
Estimates of the number differ, but there is consensus that millions of people in the US do not get enough to eat. The US also has plenty of food, so much so that many US farms receive subsidies to produce less than their full potential. Combine ample supplies of food, individuals' right to that food, and a breakdown somewhere getting the food to the right people; the only logical conclusion is that the government must step in to rectify this market failure. Indeed, the government has.
Did the federal government buy all of the food and distribute it to the people? Of course not. Government agencies and nonprofits have developed to serve specific populations. The market is functioning just fine for the vast majority of Americans, and the gaps are addressed with as little nonmarket allocation as possible so as to preserve that market. The system is imperfect, but no one is advocating a Universal Food Service approach.
The federal government has regulations mandating minimum standards for food, but this has little to do with delivering food to those who need it. Article I Section 8 of the US Constitution gives the government authority to regulate food, but only if it crosses state lines. Community gardens, farmers’ markets, local produce used in restaurants, etc. are all outside of federal jurisdiction (the idea that anything could be outside the federal government’s jurisdiction comes as a shock to many).
Programs to provide food to those in need exist alongside ("compete with") private enterprise, but the programs serve only those not served sufficiently by the regular market. A problem delivering health care to a segment of the population is similar; an underserved segment of the population is cause for targeted intervention, not cause to uproot the system with which the vast majority of Americans are quite happy.
When the government attempts to provide universal service in competition with private providers, a pattern always emerges. The government stacks the deck in the public entity's favor (e.g., the legally mandated minimum fees for couriers and delivery companies are higher than US Postal Service rates, the taxes collected to educate a child always go to a public school rather than follow the child to whatever school he/she actually attends), consumers show near-universal preference for the private version, and market distortions from stacking the deck put the private version economically out of reach of many who otherwise would choose that option.
The proper thing for these public entities to do is to contract in scope and provide only to those who need them, letting an efficient market handle the bulk of the population. Government bureaucracies don't do contraction very well, so the whole market suffers. Enacting an overbroad government health care plan would be extremely difficult to undo, so too little is definitely preferable to too much.
Subscribe to:
Posts (Atom)
