Mental Health Care

Arguing from authority is a double edged sword. With authoritarians it's never-fail, but if you lose your air of authority there is nothing left. Megan McArdle finds herself needing three mental health breaks recently, for the natives are getting restless. The problem begins when McArdle insults Rush Limbaugh and his fans, some of whom are also McArdle commenters.

I have a dilemma. The other day, I boldly stated that I could not possibly like Rush Limbaugh less. Then he went and described bullying attacks as what happens in "Obama's America"...Race-baiting is not a team sport that anyone should want to join. And I assure Limbaugh, from vivid memory, that horrible bullying also took place in Ronald Reagan's America, and every other America since at least 1978.

The only decent thing for me to do now is apologize and note that at the time, I really did not think it was possible for me to like Rush Limbaugh any less. Now I realize that I was mentally excluding all sorts of activities from the realm of the possible, like murdering boatloads of Guatamalan orphans, or this sort of vileness. It won't be the last time I'm wrong, but I certainly hope it's the last time I'm that wrong about talk radio's capacity for socially destructive quasi-populist virulent nonsense.

Many accusations of elitism later, McArdle compounds her heresy by criticizing his fans as well. They retaliate in comments, and McArdle retreats to her happy place of baby seals and friendly lions. But the unkindest cut of all comes from a much more important place, an Ezra Klein place, and it is devastating.

For a long time, I took questions about stifling innovation very seriously. So did a lot of liberals. But then I realized that the people making those arguments wanted to do things like means-test Medicare, or increase cost-sharing across the system, and generally reduce costs in this or that way, which would cut innovation in exactly the same way that single-payer would hypothetically cut innovation: by reducing profits.

I also found that I couldn't get an answer to a very simple question: What level of spending on health care was optimal for innovation? Should we double spending? Triple it? Cut it by 10 percent? Simply give a larger portion of it to drug and device manufacturers? I'd be interested in a proposal meant to maximize medical innovation. I've not yet seen one.

It turned out that concerns about innovation weren't really about innovation at all. They were just about attacking universal health care ideas of a certain sort. Which is why I stopped taking them seriously. As it is, I'm less worried about squeezing out medical innovation than I am about rising medical costs squeezing out innovation in every other sector of society. Maybe some day the situation will change, and so too will those concerns. But we're not there yet.

McArdle's authority comes from the acceptance of her peers. They made her and they can unmake her, socially if not professionally. It was extremely unwise for McArdle to draw attention to Klein's and Henley's posts because they did not mention McArdle by name. It was perfectly obvious whom they were talking about but plausible deniability works; she would have been far better off pretending they were talking about someone else. But she must insist that she is right regarding innovation, even if few people believe her anymore. She implies that the market has reached the ideal state, where pharma profits balance perfectly with innovation, and any change will upset the balance.

45 million people are on Medicare; about 45% of insured health spending is done by the government. And those drugs are not price controlled right now. The status quo is not perfect, but it's better than expanding the role of government so that there's no private pricing mechanism at all, which is something Klein et al are very much interested in.

Another classic mistake about libertarian thinking. I do not think Pharma=Good Government=Bad. I think that in a market system, prices give pharma incentive to innovate. I also think they will be happy not to innovate, if they can make money by leeching off the public purse.

[I am] opposed to more government intervention in the health care market. You can choose the slimy debating trick of framing this as "I think poor people shouldn't be insured", and I can say "You think people shouldn't have new drugs," but this is not helpful.

McArdle throws in an attack on Nancy Pelosi for balance but her heart doesn't seem into it and she turns to yet another mental health break, this time Jewish mother jokes. But this, too will pass, and the support of her employer is the only thing that really counts. They are the ones with the money.

Meanwhile, over 44,000 people die every year from the lack of health care. [pdf] Men, women and children dying right now, while McArdle files her nails and declares we live in the best of all possible worlds.