The View from Right Field

National Health Insurance – The Other Kind

When people think of health insurance, they normally think of the insurance that pays their medical bills.  And when they think of national health insurance, they think of a national system that either provides people health care or pays their bills.  England has a National Health Service that does the former.  The United States has Medicare, which does the latter.¹

But I would suggest there is another kind of national health insurance.  The purpose of this kind of national health insurance isn’t to pay bills or provide services.  It is, rather, to make sure there is enough capacity in the health care system so that you can get care when you need it, separate and apart from who pays for it.

Vaccine Equity

It’s interesting how ideas bounce around the world.  Back in February and March, the stories in the United States were about how hard it was to get the vaccine and whether shots were being distributed “equitably”.  There were complaints that minority communities were not getting their fair share of vaccines and that whites were getting shots that “belonged” to minorities.

Much the same thing happened earlier this month in New Zealand.  David Seymour, the head of ACT New Zealand, a right/libertarian party, got in trouble for publishing a “Priority Access Code for Maori” for Covid vaccinations.  But as Mr. Seymour explained, his publishing of the code had no practical effect.  The code wasn’t private; other people knew it; and the people giving the shots were vaccinating anybody who showed up anyway.  Plus, New Zealand has had fewer than 2,000 cases of Covid and just two deaths since January 1, so it really doesn’t matter the exact order in which people get shots.  The key is getting them vaccinated.

Designing Things For the People Who Use Them

Tim Harford wrote recently about the problems he had interpreting the instructions for a mail-order Covid test.¹  It was, he said, a matter of what behavioral economists call “the curse of knowledge,” i.e., “the difficulty a well-informed person has in fully appreciating the depth of someone else’s ignorance.” 

As Mr. Harford notes, “[a]nyone who has assembled a Lego set can attest that, with enough care, it is possible to provide clear instructions even for complex tasks.”  The problem is that too often people don’t take “enough care.”

Waiving IP for Vaccines – Or Actually Doing Good

The Biden administration has, perhaps not surprisingly, agreed to support a temporary waiver of intellectual property rights for Covid-19 vaccines.  It sounds good on the surface, but I can’t help but wonder if the better solution might be to just pay Pfizer-BioNTech and Moderna to make as many doses as they can as quickly as they can.  They know how to make these vaccines.  They have the best idea on how to ramp up production.  Instead of giving away IP to people and companies who may or may not know how to make these vaccines, why not just buy more doses from the people who do know how to make them. 

The United States could volunteer to pay the costs.¹  The total cost would probably disappear in the rounding with all of the programs the Biden administration is already proposing.  And giving away vaccines would be a great foreign policy move.  Russia can’t afford to do it, and China doesn’t have vaccines that work as well as these.  But we do can it.  We can help the world.  And that’s something you do when you can.

Can Washington Ignore the Coming Medicare Funding Crisis? Springfield Says Yes.

The Chicago Tribune last Friday had an Op-Ed by Robert Moffit on the coming insolvency in the Medicare trust fund.  The Congressional Budget Office has confirmed the Medicare trustees’ report that the fund, which covers hospitalization costs and related services, will run out of money in 2026.  Unlike Covid-19, this crisis has been obvious for years.  Paul Ryan was talking about it, and proposing plans to deal with it, more than a decade ago.  But Democrats ignored him and most Republicans did, too.  Especially once Donald Trump got nominated and elected.

But with date for insolvency of 2026, the headline on Mr. Moffit’s Op-Ed reads, “Washington can no longer ignore the coming Medicare crisis.”  Unfortunately, I think this underestimates our politicians in Washington.  The only choices in this situation are hard ones, and Washington has been ignoring this problem for years (as I said above), even though the solutions a decade ago would have been far easier.  I am sure the people in Washington can continue to ignore it.

Polio – and the Covid-19 Vaccine

With Covid-19 and everything else that is happening, polio isn’t something most people think about right now.  But I do – because I remember when polio was a big deal. 

In the early 1950s, 25,000 or more children were getting polio every year.  Some years it was more.  In 1952, it was 58,000, and in 1953, it was 35,000.  But then, in the spring of 1955, it was announced the Salk vaccine worked!  I don’t remember much about it, I was only six at the time, but I remember getting a shot early in the process.  Maybe it was because of what was happening in Joliet, where I lived.  I don’t know.  But what I do remember is getting that shot and how happy my mother and dad were when I got it.

And that’s why I am getting the Covid-19 vaccine.

Little Sisters of the Poor and Free Birth Control

There was considerable outcry earlier this week when the Supreme Court upheld Trump administration regulations under Obamacare that provided the Little Sisters of the Poor, and other religious groups, did not have to provide free contraceptive services under their health plan.  Well, actually, it was more complicated than that.  The Obama administration had not required the Little Sisters to provide free contraceptive services; it required the Little Sisters’ health plan to provide free contraceptive services, without charging the Little Sisters for the services.¹  The problem for the Little Sisters was, as I understand it, that they did not feel comfortable with what they had to do in order to opt-out of providing free birth control.² 

Apparently, 70,000 or more women could be left without free birth control under the Trump administration regulation, which bothers (outrages) a lot of people.  But the point is, which a lot of people seem to miss, is there is a simple way to make sure free contraceptive services are provided to all women without forcing groups like the Little Sisters to violate their religious principles: Have the federal government pay for it.  If free birth control is that important, just pass a law and provide for it.  Nobody’s religious principles are violated,³ and women get free birth control. 

We Need More Capacity in the Medical System. And It’s Going to Cost Money.

It is clear we need more capacity in the medical system.  More rooms; more ICU units; more equipment.  On hand and ready to use.  If you cut things too close, you may not have enough in an emergency or a pandemic.  

But if we want more capacity, it is going to cost money, and somebody is going to have to pay for it.  We don’t have to argue about that now.  Other things are more important at this point.  But we are going to have to discuss it in the future; when this is over.  Because more won’t be free.

Social Distancing – And Thanking Those Who Are Doing the Jobs That Let the Rest of Us Do It

We are being told to social distance.  Not just to stay away from sick people but to decrease the number of all people we come into contact with.  Society as a whole needs to increase its social distance.  And the reasons make sense, as can be seen in this article: “Why outbreaks like coronavirus spread exponentially, and how to ‘flatten the curve.’”  If we decrease the average number of social contacts we have, we slow down the spread of coronavirus. 

Which means that everybody who can increase their social distancing should do so.  Events and get-togethers that are not critical should not happen.

But there are things that are essential.  Food stores, doctors’ offices, drug stores.  They need to be open, and we need people to work in them.  And we need to thank the people who are doing the jobs that need to be done – while the rest of us increase our social distancing so the average social distance increases, and we all get through this together.

Blogging Through the Coronavirus

I probably won’t be blogging as much in the next few weeks, though with social distancing, etc., I may have more time.  Also, in whatever comments I make on current events, I will limit my criticisms to ones that are potentially useful, as opposed to ripping on people for being stupid or dumb or whatever (though there is a lot of that going on at all levels).

In looking at information on the coronavirus, one thought might be to limit what you look at to smart, thoughtful people.  That may cut down on your fear and will save you a lot of time.  Two people I would suggest following on Twitter.  First, and perhaps most important, because this guy knows what he is talking about: Scott Gottlieb, MD, director of the FDA from 2017 to 2019 (@ScottGottliebMD).  Second, Megan McArdle (@asymmetricinfo).
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UPDATE (3/15/20 11:05 am): Corrected the link to Megan McArdle.  Once again, it's @asymmetricinfo.