…and Tyler Cowen is annoyed because Aaron Carroll does not engage his main conclusions but rather picks on the little bitty "facts" he published in thee New York Times.
Aaron explains. I call this for Aaron, 6-0, 6-0, 6-0:
Tyler Cowen on me on Medicaid Wars talks about his belief that Americans will someday vote to rebel against Medicaid… says Republicans might try to take it apart… [proposes how to] alter the Medicaid expansion… [calls for] a subsidized and mandated catastrophic plan with a free market for everything else. None of that is “wrong”; it’s opinion. That’s not what annoyed me, so I didn’t write about it…. I welcomed the above.
What bothered me were [Tyler's] little snippets of information along the way….
I read in Cowen’s piece the idea that single payer systems lead to longer lines. I dispute this. Doctor shortages and an underfunded systems lead to wait times. We always point to Canada, but their wait times (overblown) are because they keep the budget down. You can have a single payer system and no wait time problem (see Medicare)…. [A]ny increase in patient coverage without increasing the doctor supply will potentially lead to longer wait times. It doesn’t matter if the coverage comes from Medicaid, Medicare, or private insurance.
I read in Cowen’s piece the idea that Medicaid has never been popular…. Does he mean Republican governors don’t like it? I agree. Does he mean there will be a political battle over it? Sure. But those are not traditional meanings of “unpopular”…. Ezra Klein says… "A recent Kaiser tracking poll found that 88 percent of Americans wanted either no reduction or small reductions in Medicare funding. At 83 percent, Medicaid was close on its heels." I don’t see that as “unpopular”….
I read in Cowen’s piece the idea that docs don’t accept Medicaid…. There’s a doctor shortage in the US, period. Lots of doctors aren’t taking new patients, period. Medicaid isn’t the worst offender here. Moreover, this issue is all about reimbursement. Medicaid gives too little. It doesn’t make me an ACA “apologist” to note that the law tries to fix that. It might work.
I read at the end of Cowen’s piece a preference for a more free market system on top of catastrophic insurance. I see no evidence for why that would be superior on cost control…. I see it as trying to move in the opposite direction of nearly every other country, and they are cheaper, universal, and often just as good.
Bottom line… memes like these… are the equivalent of “all insurance companies are evil” and “the pharmaceutical companies just want to make money and screw you”…. [T]hese [are] “zombie ideas”. I think we could make our arguments without resorting to them. I wish everyone (including Cowen) would stop using them and stick to facts.