Signs of Life

It has been an awfully long time (or so it feels) since I have written anything on the blog. So long, in fact, that I thought I should allay any concerns about my whereabouts. I’m still here in Durham, NC passing the time. For those who don’t know, I officially received my degree on May 8, and my fellowship draws to a close at the end of June.

Right now, I am figuring out what’s next, and that’s ultimately why the blog has been put on hold. First, I’ve been traveling for job interviews, which has kept me busy. Second, I’ve been thinking about the papers I want to get out of my dissertation. Third, I’ve started volunteering my time to co-author a manuscript with someone at UNC. Fourth, the blog has become a potential liability. Let me explain.

While I have always considered this a forum for the free exchange of ideas, the echo chamber phenomenon has kept most of the comments more left of center. That is, most of the people who read it seem to be liberals, and that is especially true for those who comment. That isn’t really the goal of this blog. I didn’t start it to advance an agenda or advocate a particular position. I really wanted it to be a place to present information–as close to “fact” as exists in politics. To date that hasn’t much happened, and I’ll admit, I have certainly injected personal opinions here.

In the world of non-partisan research and analysis, the appearance of opinions can be a real threat to the sense of objectivity. In some way, I do think that all researchers are biased–beginning with the questions they choose to ask, the ways they choose to answer them, and to some extent the lens through which they view the results. However, my goal is to conduct objective research, distinguishing between personal opinions and methodological rigor, and letting the data speak for themselves. Therefore, just like a judge may recuse himself or herself from a case to avoid the appearance–real or perceived–of a conflict of interest, having a blog like this may make some people–especially those who can’t validate the methods themselves–question the results of my research.

This is more of an issue with some jobs than others. But, until I figure out where I’m headed next, my desire to conduct sound empirical research is more important to me than is my desire to write this blog. So, at this point, consider things to be in a bit of a holding pattern. Perhaps pretend that you’re trying to make a connection in Atlanta. This will seem brief by comparison. Once I figure out what’s next, I’ll come back with an update. It might be the last time I write anything here, or it might not. Stay tuned.

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The Rationing Primer

If you wade through the various arguments made in opposition to governmental involvement in health care, you will soon find that it all boils down to one thing: rationing. People may speak of things like “socialized medicine” or “death panels” and make appeals to the free market as they bemoan the loss of personal freedom that they see as inherent in any health care system with almost any level of governmental involvement. What they are really saying is that they are worried that the government will make decisions for them and that they may not agree with the decisions that are made on their behalf. They are chiefly worried about rationing, which they define as the government refusing to pay for a health care good or service that the person anticipates they might benefit from some day. In fact, they often seem to think that the government will literally prohibit them from seeking the care they anticipate needing at some point in the future.

I will grant them that if such things were true, they would be terrifying. Thankfully, they aren’t true at all. What’s perhaps more alarming is how some people’s definition of rationing has grown so limited. Compare people’s concerns with the present reality: They are worried that government will make decisions on their behalf, which they may not agree with. Why then are they not equally as worried about all of the decisions already being made on their behalf by the employee benefits managers at the places where they work or by the claims specialists at their insurance companies? It seems to me that both situations violate the principal that individuals should be free to make their own decisions. People are also worried that the government will “ration” by preventing them from getting the care they need. The reality is that the government has no such authority and that money talks.

Here we are introduced to the true meaning of rationing, where prices dictate the exchange of goods and services. Today, anyone with enough financial resources can make an appointment with any doctor they choose, get any services they need, and so on. They don’t need insurance. They can, in effect, self-insure, and no health reform will change that. If the “Big Brother Plan” doesn’t cover something they need, they can simply pay out-of-pocket and get whatever care they want.

The flip-side of this is that those without the financial resources to do so cannot be assured of getting the care they need. Today, there are people who go without. Why? Because we ration care based on the ability to pay for it, and not everyone is able to do so. Health reform is designed to help these people gain access to basic medical care. Many of us, it seems, are unwilling to believe that this is rationing. Others surely understand the current system, and simply fear that in a world where rationing is inevitable, giving to those who have not will necessitate taking from those who have. To some extent they are right. However, the impact of that transition can be lessened by capitalizing on the reduction of systemic inefficiencies. Moreover, none of us can be certain that we will not fall catastrophically ill in the future, and if such a fate should befall us, I imagine that we will hope desperately for a system to come to our aid, rather than resign ourselves to suffer as victims of a system motivated by unabashed self-interest.

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Some New Data Sources

Happy May Day! Two quick links for those of you who a.) read the blog (all of you) and b.) are always looking for new datasets to put to good use (far fewer of you). Get yourselves a little of this and that.

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