Is Greg Mankiw really as stupid as he pretends to be?

No, he just hopes you are. Yes, the Ryan plan is a lot like Obamacare. That means that it’s better than nothing, but worse than Medicare. So providing subsidized access to the health insurance market to those who had nothing was progress; pushing people who have Medicare back into the insurance market would be regress.

He writes:

Representative Paul D. Ryan, Republican of Wisconsin, has attracted much attention with his plan to reform Medicare. He proposes replacing the current fee-for-service program, in which the government picks up the bill for medical expenses, with a “premium-support” system in which seniors use federal dollars to choose among competing private insurance plans.

Democratic critics of the plan suggest that enacting it would be akin to pushing Grandma over a cliff. But they rarely point out that the premium-support model is in some ways similar to the system set up under President Obama’s health care law. If choosing among competing private plans on a government-regulated exchange is a good idea for someone at age 50, why is it so horrific for someone who is 70?

Hummm … let’s see … that’s a hard one … gimme a second …

Maybe – possibly – because subsidized access to the private insurance market is better than nothing but not as good as Medicare?

The most valuable lesson economics teaches isn’t a proposition, it’s a question:  “Compared to what?” Providing subsidized access to the health insurance market to those who had nothing was progress; pushing people who have Medicare back into the insurance market would be regress.

No, of course Mankiw isn’t that stupid. He just hopes you are. And this is a senior intellectual adviser to the official “moderate” Republican candidate for President. And a tenured professor at Harvard. Feh.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

25 thoughts on “Is Greg Mankiw really as stupid as he pretends to be?”

  1. “the premium-support model is in some ways similar to the system set up under President Obama’s health care law.”

    And, in at least one way, it is not similar: it subsidizes those who cannot afford insurance less adequately than does Obama’s plan. I’m pretty sure that I got that from Krugman; perhaps someone else can elaborate.

  2. There are significant differences between a 50 year-old person and a 70 year-old one. A fifty year-old are generally much healthier, so their health insurance costs will be much lower. They’re working and can therefore better afford to pay the premiums. They’re more mentally fit and agile and can better negotiate the complex thicket of insurance plans, premiums and benefits.

  3. This has been going on long enough that it’s unfair to continue to presume that Mankiw is pretending. Maybe he was at first, but by now he’s convinced himself to be stupid and he truly believes in being a flaming idiot. He’s an economist the way Bill Frist was a doctor in the Terry Schiavo affair, i.e. not at all because he had explicitly rejected all the tenets of his former profession.

  4. The attraction of Obama’s plan for the medical services industry, for the insurance companies, for Big Pharma and the rest — the bait as it were — was the opportunity to make money from the expansion of the market. To speak plainly, the attraction was the expanded opportunity for predation. This was the design principle that guided the Obama plan, above all else. The nice way of saying it, at the time, was to argue that it was politically pragmatic, “the” way to get “a” plan passed.

    The attraction of Ryan’s Medicare plan is the same: increased opportunities for business predation.

    A working political power coalition, which includes the Obama Administration, exists for finding increased opportunities for business predation.

    What isn’t clear is that any effective opposition to this way of politics exists. The Obama Administration, on issue after issue — the stimulus, foreclosure relief, TARP, financial reform, the Consumer Financial Protection Bureau, Fannie and Freddie, health care reform, the Bush Tax Cuts, Social Security reform, deficit reduction — marginalizes the progressives and legitimizes the Republican agenda and talking points.

    Mankiw is just enjoying the fruits of that legitimatizing effort. The Overton Window has moved, and Obama moved it. Two days ago, Mark was sarcastically praising Michelle Bachman’s “brilliance” for suggesting that Obama had a secret plan to destroy Medicare.

    This isn’t about Mankiw or Bachman. And, neither is stupid. This is about the politics of Obama. It is about what happens when the leader of the “progressive” party is actually working for the plutocracy, and no effective opposition to the conservative economic agenda can form.

    Democrats, who favor Medicare-for-all were shoved into the ditch a long time back. Democrats, who wanted even such a mildly anti-predatory measure as the public option were thrown under the bus. This is the consequence.

  5. (Kleiman): “Providing subsidized access to the health insurance market to those who had nothing was progress; pushing people who have Medicare back into the insurance market would be regress.
    Why? Because you say so?
    I have sad news for you’all: we are all born terminally ill. You could spend the entire Earth’s GDP on medical care for Professor Kleiman alone and it would not be enough. You are going to die. Just days ago, Professor Kleiman characterized acceptance of death as “wisdom.” How times change (in a week or less).

  6. Malcolm, your capacity for not seeing (or pretending not to see) the point is truly world-class. It’s better from the viewpoint of the person receiving the benefit to have subsidized access to the private insurance market than to have nothing, but not as good as having coverage you don’t have to go into the market to buy.

    And of course we’re all going to die. The questions that health-care reform can influence are: (1) How soon; (2) How healthy we are before we die; (3) The quality of the care we receive when sick; and (4) Whether getting sick constitutes a personal and family catastrophe. You’re entitled to prefer faster/sicker/worse/yes as the answers, but not to pretend there’s no question.

  7. If anything, I think you’re understating the dishonesty here; the plan is to switch to vouchers and then devalue the vouchers. It’s a neat trick: privatize/voucherize which saves no money, then slash benefits, attributing the money saved to privatization. Afterwards, pretend criticism of the benefit-slashing is actually criticism of the privatization. It’s breathtakingly dishonest, and Greg Mankiw’s been pulling similar tricks for a while, which is why I’m glad you’re calling him out on it.

  8. I wonder whether Malcolm will follow his insight to its logical conclusion and open his veins in the bath tonight. By doing so he would, if nothing else, improve the quality of the comments here.

  9. What Mrs Tilton said. I am so tired of having to sort through garbage in order to find interesting comments – of which this site has far more of the latter than the norm, perhaps because it requires at least a modicum of literacy in order to even pretend to address the topic.

  10. The really cool thing about Malcom, if you’re into troll performance art, is if you have listened to his narrative it is impossible to avoid the conclusion that he has been a social parasite, sucking at the public teat, all his working life (his description). Nowadays he is having both his pocket cash and his health care are provided by the rest of us, while he produces nothing of value at all, not even the possible value (if dubious) of his teaching his unfortunate students arithmetic. His current function as a human being (if he is indeed that) is to consume our cash, try to destroy the prospects for our children, and leave enormous bullshit droppings all over this blog. I am not even sure he is sane. But then, he’s a Republican.

  11. A good single payer program like Medicare is significantly better than a carefully designed program which makes it possible for people to buy private insurance like Obama’s law which is significantly better than a cheap program to partially subsidize people’s purchase of private insurance like Ryan’s proposal which is significantly better than nothing.

  12. (Kleiman): “Malcolm, your capacity for not seeing (or pretending not to see) the point is truly world-class.
    Characteristic Kleiman.
    (Kleiman): “It’s better from the viewpoint of the person receiving the benefit to have subsidized access to the private insurance market than to have nothing, but not as good as having coverage you don’t have to go into the market to buy.
    Dollar-denominated medical care vouchers are hardly “nothing”. They place an explicit limit on the taxpayers’ exposure to potentially open-ended health care costs. We disagree about the relative merits of a State-monopoly provider of treatment (or insurance) against a market (voucher-subsidized or unsubsidized) in medical services or medical insurance. I recommend the Brookings study __Vouchers and the Provision of Public Services__.
    (Russell): “Malcolm…has been a social parasite, sucking at the public teat, all his working life (his description).
    False. I’m 62. I worked as a diver for HIMB for a total of six months, in the US Navy for a 2-year active stint (2×6), in the Hawaii DOE for 2 years part-time and 10 years full time. That’s the extent of my government employment. Further, I don’t see that free-marketeers have an obligation to shun State employment in a socialist economy. I play by the rules, even as I appeal for a chande in the rules.

  13. Malcom, you’ve been a social parasite in a variety of contexts for well over ten years. Without The State, you’d be destitute. You should swear right here and now to forbear any participation in Medicare and Social Security in a few years. It’s beneath you, after all. You have your dignity as an autonomous Human Being to preserve. Or maybe, you’ll just give up and be… a parasite… sucking the money out of us productive members of society? I’m not holding my breath.

  14. (Russell): “You should swear right here and now to forbear any participation in Medicare and Social Security in a few years.
    As I said, I play the game by the rules as they are currently written, while arguing for a change in the rules. Isn’t that how citizenship works in a democratic republic?
    (Russell): “It’s beneath you, after all. You have your dignity as an autonomous Human Being to preserve. Or maybe, you’ll just give up and be… a parasite… sucking the money out of us productive members of society?
    I have not used the services of a medical professional in nearly twenty years. I am not counting on Medicare or Social Security. I’m vested in the State health care system for former employees (after ten years). That’s an onen-ended committment with no explicit dollar cap which the State will soon find unaffordable. I’ll be happy to give it up when a majority of voters accept that they cannot afford it.
    You’re a Social Studies teacher, is my off-hand guess.

  15. “You’re a Social Studies teacher, is my off-hand guess.”

    That made my day, thanks! I showed it to my wife and she had
    a good laugh too. Trolls these days! No google skilz.

    “I am not counting on Medicare or Social Security.”

    Ah then it is an easy thing for a person with your calcified ideology to proclaim:

    “I shall never take a dime in benefits from either Medicare or Social Security! I am a Free Man!”

    Can you do that, please?

    And that “State health care system”, hmm, that smells like socialism. Aren’t you worried about corrupting your soul? Ah right I forget so easily, Malcom is all for himself, just not for anyone else. Now that you’re 62, endgame in sight, it’s easy to say, f**k’em, I got mine.

    You’re a fraud, Malcom. The sooner you understand, the sooner you can heal. That’s what we want. A healthy Malcom.

  16. (Russell): “ Trolls these days! No google skilz.
    I did not bother to try. Should I?
    (Russell): “…Can you do that, please?
    I could, but won’t. As I wrote: I play the game by the rules as they are written.
    (Russell): ““State health care system”, hmm, that smells like socialism.
    The welfare State, more precisely. The State does not require that I seek treatment from State employees.
    (Russell): “Aren’t you worried about corrupting your soul? Ah right I forget…
    Rather, “fantasize”.
    (Russell): “…so easily, Malcom is all for himself, just not for anyone else.
    That’s the socialist rap on free marketeers, anyway.
    (Russell): “…Now that you’re 62, endgame in sight, it’s easy to say, f**k’em, I got mine.
    That’s the socialist rap on free marketeers, anyway.

  17. At least Malcom stopped changing my speling of his name in his quotes. I certainly enjoyed that. For the rest he seems to have a scratch on the vinyl lp that he plays on his eternal adolescent turntable, eh? But we knew that. Malcom is not well in the head.

    Well off to finish the double rack of ribs and the rest of the spread here in the socialist paradise of rural Arizona. Happy Fathers Day to all.

  18. Mankiw: If choosing among competing private plans on a government-regulated exchange is a good idea for someone at age 50…

    A good idea? Perhaps for market fundamentalists. The rest of us know it is a kludge doomed to failure. It merely keeps the middleman (private insurers) in the game for a while longer. The bottom line is that the free market does not function adequately in the healthcare insurance business. It is a a failed model that has been given a stay of execution and yet another decade to prove again it can’t succeed. Moneyed elites will continue to skim off billions in the exchange of money for services between citizens and their healers. That is, until the cost curve forces us to reform them out of that business once and for all.

    This delay to the true solution to healthcare is the price all of us have to play because our Congress has been purchased by these elites and their attendant corporate lobbyists.
    So please, cut the crap about it being a “good idea”. It’s a rotten idea wrapped up in mendacity and sold to us under expediency.

    An interesting side observation:

    Cutting out the middle man to reduce costs is smart capitalism only when it is implemented by Galt in the private sector.
    When the government does it, it’s socialism.
    And yet note: the end result (cutting costs) is the same one (!).

  19. Y’all (not you’all – what is that, a non-contracting contraction? Malcolm was an English teacher, is my off-hand guess) gotta admit, Malcolm’s comments have huge entertainment value. Like last week when I took my grandkids to the zoo and we watched primates fling their dung around.

    I’ve noticed that nearly every time Malcolm joins a thread, he starts out by taking one of Mark’s previous statements completely out of context and trying to use that to show hypocrisy on Mark’s part. Today it’s Mark’s previous comment concerning the possible *spiritual* effects of hallucinogens, one of which was a lessened fear of death, and contrasting that with today’s advocacy for preventing unnecessary premature death. But the richest one in recent memory was this thread a few days ago where he implied that Mark was hypocritical for calling Palin dumb by conflating that with violent and slanderous rhetoric Mark had previously criticized while at the same time calling Mark dumb, and then accused him of substituting personal attack for considered argument. I’d suggest taking up a collection to see if there’s some way to medically restore his sense of irony, but I suppose he wouldn’t care for that idea either.

    Thanks for another ROFL moment, Malcolm. But seriously, if you haven’t used the services of a medical professional in nearly twenty years, at the age of 62 perhaps you should think about swallowing your pride and using your contemptible State health care benefits to get a check-up. Alzheimer’s and dementia are treatable these days, you know.

  20. Under a Ryan voucher plan, the best anyone could hope for would be a plan like Kaiser mostly paid for by the voucher. All the Ryan plan does is shift the burden from “all the taxpayers” to “all the taxpayers over 65”. Does anyone really believe that increasing the burden of providing healthcare from all the taxpayers to to only the taxpayers above 65 will do any good at all? Shifting the burden to medicare recipients is equivalent to taking away about half of their social security payment. Private insurance companies don’t even want to insured people over 50, except under plans where the insured is responsible for over half of their usual expenses as out of pocket deductibles and where they still are responsible for more than $500 a month in premiums. All the Ryan plan does is take away all of the disposable income for most social security recipients. Bye bye American Dream.

  21. Alan, under Ryan’s plan, wouldn’t all the taxpayers still bear the burden of the vouchers, as inadequate as they would be? If so, then the Ryan plan would shift some but not all of the burden from all the taxpayers to all the taxpayers over 65.

  22. “…the premium-support model is in some ways similar to…President Obama’s health care law.”

    Which is true, but only in trivial ways. A program of hiring fifty thousand government workers to travel door to door and hit senior on the head with hammers while shouting “Medicare!” would be “in some ways similar to” the system we have today:

    1. It would be called “Medicare.”
    2. It would be paid for by the government.
    3. The treatements it pays for would occasionally result in negative side-effects.

    While we’re at it, I am “in some ways similar to” Ryan Reynolds, People Magazine’s current “sexiest man alive,” in that I have two arms and two legs.

    N. Gregory Mankiw: professional idiot.

  23. Under the current insurance systems providors have financial and emotional incentives to provide care without regard to cost effectiveness critera. Patients have an emotional incentive to seek as much care as as could conceviably be of benefit. Under the current Medicare system an increasing share of transfers are being sucked up by medical care for the elderly, many of whom are much better off than younger generations. This situation is not sustainable. Designing a sustainable and reasonably efficient system will require some consensus on the acceptable growth rate of socially supported health care. Seniors, I am one, differ from the non-elderly population in that most of have or will soon have one or more chronic condition. A model in which we can jump from private or public plan to public or private plan depending on our conditions will not be sustainable. Ultimately care is rationed either through a market system or through an administrative system. Until we recognize that cost savings means cutting the income of physicans and hospitals, reducing the extent to which we pay to delay death, reducing ineffective and or dangerous treatment and requiring standards of care for reimbursement medical costs will continue to sap our ability to pay for other socially desirable services

  24. The other important aspect of Ryan’s voucher proposal is that the growth rate of the vouchers given to seniors to purchase insurance would be capped at the rate of inflation, but health care costs have typically risen much faster than inflation. The GOP argument is a magic asterisk – that somehow, seniors would be able to invoke market forces to constrain health insurers to slower cost growth.

    Instead (as Mankiw surely knows) you have a cost shift – from the government to individual insurance purchasers. Additionally, the CBO estimates that privatization would be more expensive than traditional Medicare, but by 2030 seniors would be paying two-thirds of the costs, not one-quarter of the costs under the current structure.

  25. Mankiw has graduated, I think, to the Scalia level of intellectual output. He is in a tenured position of power, people will publish pretty much whatever he says because he is who he is, and some not-insignificant group of people people know that their future careers depend on acting as if he’s making profound sense. It’s gone to his head, because it’s not even as if something like this will convince anyone who doesn’t already believe it.

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