Health Care Policy Chaos

We were assured by Nancy Pelosi that we would have to pass health care reform in order to find out what was in it. We did, and most of the revelations about the details of the bill have been disquieting, to say the least. But at the very least, we're no longer information-starved, right?

Alas, wrong:

Alabamians hoping to find health insurance through a new federally developed insurance marketplace won’t get any details before October, when the insurance options are scheduled to go online.

The U.S. Department of Health and Human Services reports it is working on completing the list of health insurance plans that will be made public Oct. 1, when people can begin signing up for coverage that will start Jan. 1. That gives the uninsured a three-month window to comply with the Affordable Care Act’s mandate for individuals to have health insurance by Jan. 1 or face penalties at tax time in April.

“It’s frustrating that we are not going to be able to get a preview,” said Jim Carnes, spokesman for Alabama Arise, a Montgomery-based organization that addresses issues affecting Alabama’s poor. Because of that, Carnes predicts a slow start to people signing up.

I am betting that Alabamians are not alone in wondering what is in store for them. Meanwhile, yet another news item telling us that the health insurance exchanges are not ready for prime time. And another unwelcome wrinkle in the law reminds us just how poorly constructed it is:

A "family glitch" in the 2010 health care law threatens to cost some families thousands of dollars in health insurance costs and leave up to 500,000 children without coverage, insurance and health care analysts say.

That's unless Congress fixes the problem, which seems unlikely given the House's latest move Friday to strip funding from the Affordable Care Act.

Congress defined "affordable" as 9.5% or less of an employee's household income, mostly to make sure people did not leave their workplace plans for subsidized coverage through the exchanges. But the "error" was that it only applies to the employee — and not his or her family. So, if an employer offers a woman affordable insurance, but doesn't provide it for her family, they cannot get subsidized help through the state health exchanges.

That can make a huge difference; the Kaiser Family Foundation said an average plan for an individual is about $5,600, but it goes up to $15,700 for families. Most employers help out with those costs, but not all.

"We saw this two-and-a-half years ago and thought, 'Has anyone else noticed this?'" said Kosali Simon, a professor of public affairs at Indiana University who specializes in health economics. "Everyone said, 'No, no. You must be wrong.' But we weren't, and that's going to leave a lot of people out."

The issue has recently received attention, especially after former president Bill Clinton highlighted it in a recent speech.

"The family glitch is definitely a drafting error that Congress made that needs to be fixed," said Joan Alker, executive director of the Georgetown University Center for Children and Families. "But that seems unlikely."

New rules state that those families will not be penalized for not purchasing coverage, but the point of the law was to make coverage affordable for families.

Jonathan Adler offers apt commentary: "It’s almost as if no one carefully read the bill that was passed. After all, this is hardly the only instance in which the text of the statute does something different than what the supporters had hoped."

In Memoriam: Ronald H. Coase

The great man lived for over a century, but as is the case with the passing of other great and productive minds, one feels as though the world did not have him for nearly as long as he was needed. Here is the University of Chicago Law School remembrance, which helps sum up his extraordinary legacy:

Coase, the Clifton R. Musser Professor Emeritus of Economics, is best known for his 1937 paper, “The Nature of the Firm,” which offered groundbreaking insights about why firms exist and established the field of transaction cost economics, and “The Problem of Social Cost,” published in 1960, which is widely considered to be the seminal work in the field of law and economics. The latter set out what is now known as the Coase Theorem, which holds that under conditions of perfect competition, private and social costs are equal.

“That Ronald Coase is among the most influential and best-cited economists in the past 50 years is not debatable,” said Law School Professor Emeritus William M. Landes and Sonia Lahr-Pastor, JD '13, in “Measuring Coase’s Influence.” They presented the paper at a 2009 conference titled “Markets, Firms and Property Rights: A Celebration of the Research of Ronald Coase.”

“Among the highest aspirations of the University of Chicago is the drive to create new fields of study that change our world for the better,” said University of Chicago President Robert J. Zimmer. “Ronald Coase embodied that ideal. His groundbreaking scholarship made impacts on law and policy that people around the globe continue to feel today. As a scholar, a colleague and a mentor, his historic contributions enriched our intellectual community and the world at large.”

“Ronald Coase achieved what most academics can only dream of – immortality,” said Michael H. Schill, dean of the University of Chicago Law School. “His scholarship fundamentally changed the way lawyers approach issues of when and how government should intervene in the economy, and when and how private contracts should govern. His work could not be more relevant to many of the debates we are enmeshed in today.

“Our great law school has contributed much to the world of law and jurisprudence,” Schill said. “Ronald’s contributions were among the most important.”

His intellectual impact continued late into his life, when at the age of 101, he published his final book, How China Became Capitalist, co-authored with former student Ning Wang, PhD’02.

Read the whole thing. Here as well is the New York Times obituary. My favorite passages from the piece:

In his autobiographical essay written for the Nobel committee after being awarded the prize, he recalled being taken by his father at age 11 to a phrenologist to hear what could be discovered from the shape of his head. The phrenologist detected “considerable mental vigor,” Professor Coase wrote, and recommended that he work in banking or accounting and raise poultry as a hobby.

[. . .]

While teaching at the University of Virginia, Professor Coase submitted “The Problem of Social Cost” to The Journal of Law and Economics, a new periodical at the University of Chicago. The astonished faculty there wondered, according to one of their number, George Stigler, “how so fine an economist could make such an obvious mistake.” They invited Professor Coase to dine at the home of Aaron Director, the founder of the journal, and explain his views to a group that included Milton Friedman and several other Nobel laureates-to-be.

“In the course of two hours of argument, the vote went from 20 against and one for Coase, to 21 for Coase,” Professor Stigler wrote later. “What an exhilarating event! I lamented afterward that we had not had the clairvoyance to tape it.”

Jonathan Adler writes that "[m]ost of us [academics] would be lucky were our entire body of work to have the impact of just one of his articles." Ilya Somin also has some appropriate thoughts for the occasion:

One of my personal favorite Coase articles is “The Lighthouse in Economics,” where Coase shows that private entrepreneurs successfully established and operated an enterprise that most economists believed was the classic example of a public good that could only be provided by government. This doesn’t prove that the private sector can provide all public goods (nor did Coase claim that it can); but it does show that we should be more careful than we usually are in asserting that a given good can only be provided by the state just because it is public in nature. Before Coase, most scholars and public policy experts had simply assumed that the private sector was incapable of providing lighthouses without much investigation of the issue.

Richard Epstein, who was a longtime colleague of Coase's, also adds his thoughts:

Why was Ronald so great? The answer is not because he was smart. In fact, I suspect that by the usual measures of intelligence Ronald would not do well against the types who excel in proving mathematical theorems or solving crossword puzzles. No, Ronald was not "smart."  But he wasbrilliant. He could look at the most mundane facts of ordinary life and distill from them insights about how the world worked -- and, indeed, had to work

To make the point more generally, the idea that social interactions took place in a frictional universe was not first discovered by Ronald. The point was in the background of virtually every discussion of the operation of the legal system from the beginning of legal history. But lawyers, in particular, are creatures of doctrine, and their first intuition was to look for elegant points of law over which to argue in the manner of great appellate lawyers and to ignore the inconspicuous substrate on which the entire system rested.

To put it otherwise, what he did was make friction the main event in all cases, not just a sideshow. He did it first when, in The Nature of the Firm, he asked the simple question of why individuals sometimes form firms to organize their business and on other occasions resort to the price system to exchange goods. No one before Ronald has put the point exactly in that way, and yet, once the question was made, his simple answer—namely, that it is costly to form a price system and costly to form a firm—started a huge rush of productive scholarship. No longer does one think of business entities as suspended in space. It is not possible to ask when the transaction costs are higher in the one direction than in the other, so that there is a kind of balance that explains why both types of arrangements are so commonplace.

From there, it turns out that the study of partnerships, corporations, lending agreements, joint ventures, and a host of other arrangements are all amenable to the transaction costs analysis. At each stage in the analysis, we are always sure that there has to be something more to the overall system. But in each case, supposed side constraints fit very well within the simple model that Ronald developed by asking the right question and then looking hard at the everyday facts of the world to see how it operates. 

What is obvious now was not obvious then, which is why Coase is not just a distinguished person, but the champion of a worldview—the Coasean worldview—which will rank up there, when all is said and done, with the Hobbesian, Lockean, and Humean views of human nature -- and not just because he shares with them the inestimable advantage of a one-syllable name.

Some wise words from Coase, courtesy of Geoffrey Manne. Coase's skepticism of regulation is worth keeping in mind, especially given the plethora of regulation-happy politicians and online pundits. I will close this post by noting Peter Klein's comment on how Coase constructed his extraordinary oeuvre "despite — or because of? — not holding a PhD in economics, not doing any math or statistics, and not, for much of his career, working in an economics department."

Requiescat in pace.

What Justice Ginsburg Gets Wrong

Her disparagement of the Roberts Court notwithstanding, it is not an activist Court:

Justice Ruth Bader Ginsburg believes the Roberts Court is “one of the most activist courts in history,” according to a widely cited interview with the NYT‘s Adam Liptak.   ”Activist” is a slippery label, often indicating nothing more than disagreement with a Court’s decision in a given case.  fortunately Justice Ginsburg provided Liptak with a definition.  Specifically, Ginsburg told Liptak that “if it’s measured in terms of readiness to overturn legislation, this is one of the most activist courts in history.”  This is one way to define judicial activism, but if this is the definition Justice Ginsburg wants to use, her accusation falls wide of the mark.

If activism is “measured in terms of readiness to overturn legislation,” the current Court is not one of the “most activist courts in history,” at least not compared to others of recent memory.  As Liptak’s own reporting has shown,the Roberts Court is the least activist Court of the post-war period by this measure, invalidating federal statutes far less often than did the Warren, Burger, or Rehnquist Courts.  Liptak wrote his earlier story in July 2010, but the conclusion still holds.  Since 2010 the rate at which the Roberts Court has struck down federal legislation has actually declined.  According to the same report, the Roberts Court overturns precedent at a lower rate than did prior post-War courts.

If in calling the Roberts Court  ”one of the most activist courts in history,” Justice Ginsburg meant that the Roberts Court is more activist than, say, the seriatim or Marshall Court, she has a point. If she meant to imply the Roberts Court is any more “activist” than any other court in the past 60 years, she doesn’t.

Maybe the New York Times should correct the record on this point. You know that they would if John Roberts, Antonin Scalia, Clarence Thomas or Samuel Alito made a similar boo-boo.