I’ve recently done posts on America’s financial system as well as its health care system. I view both systems as borderline disasters, and more particularly socialist disasters. In my previous post, I lamented that the taxpayer now assumed so much risk from bank deposits that banks were encouraged to take excessive risks, leading to occasional financial crises.
In the post on health care, I discussed how the US government spent even more than European governments, but with far less to show for it. But even the 8% of GDP spent on public health programs greatly understates the US government’s footprint. The government also provides huge tax breaks for private health insurance, which greatly distorts decision-making (including my own personal decisions.)
Some conservatives don’t view tax breaks as “government spending”, because the money is returned to the public. But in an economic sense, the following two programs are identical:
1. A 30% flat rate, with no deductions, and a welfare program giving everyone $5000.
2. A 30% flat rate tax, with a $5000 tax credit for each person.
While those two regimes are essentially identical, there are treated very differently in any statistical rankings of various countries. In case #1, the $5000 welfare program is treated as government spending. In that case, both tax revenue and government spending are considerably higher than in case #2.
Our current income tax system with deductions for health insurance (contributions are both payroll and income tax free) is actually equivalent to a system with higher taxes and explicit government subsidies to buy health insurance. Thus instead of spending 8% of GDP on public health care, we are likely spending more than 10% of GDP, when tax breaks are added in. The way this distorts our behavior is a huge problem.
When I talk to conservatives, I often feel like they are too inclined to defend our financial system and our health care system. They see the left criticize these two systems, and they rightly recoil from the socialist arguments used by the left. But just because the left is wrong in their proposed solutions, doesn’t mean that the left has not correctly identified some highly flawed policy regimes. Both regimes seem indefensible to me, not justifiable on either equity or efficiency grounds.
Conservatives often talk about the problems with regulation, and the need for free choice. But the massive subsidization of risk in these two systems means there is no free choice to begin with. Fans of free markets should never be put in the position of defending regimes that are so distorted by subsidy and other regulations. Our financial system is equivalent to a regime where every bank deposit is first lent to the Treasury, and then re-lent out to a commercial bank. How is that not socialism? Conservatives complain about proposals to allow private bank accounts at the Fed, but why isn’t the current system just as bad?
Eventually, the internal inconsistencies of these two systems will become unsustainable. Who will the public look to for solutions? Those who defended the regimes, or those who had for decades been pointing to their flaws?
Here’s Robert Kuttner, reviewing a book by Adam Tooze:
The historian G.M. Trevelyan said that the democratic revolutions of 1848, all of which were quickly crushed, represented “a turning point at which modern history failed to turn.” The same can be said of the financial collapse of 2008. The crash demonstrated the emptiness of the claim that markets could regulate themselves. It should have led to the disgrace of neoliberalism—the belief that unregulated markets produce and distribute goods and services more efficiently than regulated ones. Instead, the old order reasserted itself, and with calamitous consequences. Gross economic imbalances of power and wealth persisted. We are still experiencing the reverberations.
I think Kuttner’s wrong; the Great Recession showed that the world needs more neoliberalism. He (implicitly) focuses on time series evidence, whereas cross sectional evidence is far more meaningful. The more neoliberal the country, the better it’s done over the past decade.
But Kuttner’s argument has more intuitive appeal to the average voter. I’m just as surprised as he is that neoliberalism hasn’t suffered an even greater setback as a result of the global financial crisis of 2008. But suppose it happens again. Suppose the “deregulation” I discussed in my previous blog post allow reckless mid-sized banks to make extremely risky loans to property developers, and then it all goes bad. Who will be blamed? Those who wrote Dodd-Frank? Or those who weakened the rules so that mid-sized banks could more easily take socially excessive risks?
If the health care system keeps getting more dysfunctional, are voters going to turn to the group that persistently defended the US system as best in the world? Or those who criticized the system?
Conservatives need to remember that the “liberty” to spend or loan out government subsidized funds is not true liberty.
READER COMMENTS
RPLong
Nov 16 2018 at 10:26am
Your previous post on healthcare is titled, “The case for European health care.” You lead into your argument by stating,
And yet, you later stated in the comments of that post (emphasis added):
Perhaps it’s true that some people are too quick to defend the American system. But it may instead be true that your rhetorical style of presenting proposals that you actually oppose is eliciting a more antagonistic response than you’d get if you only presented proposals that you support.
Also in that previous post, you wrote, “When you are spending 8% of GDP, the burden of proof is on those who claim effectiveness, not those who are skeptical.” I called you out on this in my comment under that post. Your approach here seems to be one of assuming that anyone who is opposed to a European-style health care system for any reason is automatically in support of the current American system.
Perhaps people are too defensive about the American system, or perhaps you’re assuming they’re defending a bad status quo, when in reality they’re merely criticizing a bad alternative. (Remember, you can’t say it’s a bad alternative since you already said you oppose it! 🙂 )
Floccina
Nov 16 2018 at 2:23pm
Yup, the Federal reserve system today looks like a single giant bank that does too little police it subsidiaries.
I like George Segin’s idea that the Government should create some base money that would be used like gold was in the Scottish free-banking period and not banks create most hand to hand cash. The Government still has the ability to create more base money if need be but it would up to the banks to keep the price level reasonable and they could less regulated. This solves the problem of down turns causing people hold more cash and equivalents (because they trust government much more that businesses) causing a contraction in the money supply.
Tom
Nov 16 2018 at 4:37pm
Deregulation and the removal of moral hazard would be ideal, but I agree that the political tides are moving in the opposite direction. Are there ways we can improve healthcare and the financial system as the government becomes more involved?
If the US is moving to single payer healthcare, maybe libertarians should push for a tweak where every American is provided Medicare for free, but individuals are also allowed to purchase additional healthcare / insurance in an unregulated / unsubsidized market. Or allow direct banking with the Federal Reserve, but also abolish the FDIC and allow individuals who want to take risks to deposit their money at banks without a government guarantee.
The end result would be two health care and two financial systems side by side: real socialism and real free markets, instead of the less functional semi-free, semi-socialist systems we have now
Alan Goldhammer
Nov 17 2018 at 9:35am
Tom writes, “If the US is moving to single payer healthcare, maybe libertarians should push for a tweak where every American is provided Medicare for free, but individuals are also allowed to purchase additional healthcare / insurance in an unregulated / unsubsidized market.”
As I have repeatedly noted in replies to various posts on this blog, this type of system has already been proposed. Back in 2007, Zeke Emanuel and Victor Fuchs came up with a voucher system (Frank’s article contains a link to the full proposal) that would provide funds to purchase private insurance policies. This program ends employer funded policies, Medicare and Medicaid as everyone now has the funds to purchase a basic healthcare policy. There would be aftermarket policies for those who desired coverage beyond the basic, sort of the way Medigap policies operate for those with Medicare today. Program is funded via a VAT.
Thaomas
Nov 16 2018 at 5:04pm
” Who will the public look to for solutions? Those who defended the regimes, or those who had for decades been pointing to their flaws?”
I agree and I’d say the same to both conservatives and those on this blog who do not propose something more than do noting and hope about climate change.
Scott Sumner
Nov 16 2018 at 7:16pm
RPLong, I should have been clearer about the European health care system. I meant that I’d support converting our system to the European system, by I’d oppose the European system if starting from scratch.
Alan Goldhammer
Nov 17 2018 at 9:37am
Scott – It might be nice to have a post outlining your thoughts on what a system would look like if we did start from scratch.
Scott Sumner
Nov 17 2018 at 11:02am
Something closer to Singapore–very low government spending. (They spend 2% of GDP)
ChrisA
Nov 18 2018 at 11:26am
According to Bloomberg Hong Kong is even more efficient;
https://www.bloomberg.com/news/articles/2018-09-19/u-s-near-bottom-of-health-index-hong-kong-and-singapore-at-top
Hong Kong has a UK style health service not a savings system like Singapore. I think the underlying genetics are most of the reason for low health care cost countries – not the design of the system.
Benjamin Cole
Nov 16 2018 at 7:24pm
Rarely mentioned is that America’s right wing is a fervent supporter of full-fledged national-scale communist healthcare programs.
About 22 million former federal employees qualify for free lifetime medical care in 172 federally owned hospitals, staffed by federal doctors, nurses and administrators. All of it 100% paid for by income tax payers. Of course, this is the VA.
America’s most amplified free-market theologians generally go mute on the VA. But then, discretion is the better part of valor.
Thomas Sewell
Nov 16 2018 at 8:22pm
Scott,
Your overall point is substantially correct. One nit to pick, though:
In practical economic terms, a welfare program in the U.S. giving everyone $5000 is going to cost perhaps 10% more than $5000 due to the additional overhead involved, while a flat $5000 tax credit will cost much closer to $5000, even including the minimal paperwork costs involved.
As with your European case, an ideal situation would be no special tax treatment for medical insurance, but if that isn’t practical politically, then an improvement on the current system would be to equalize the tax treatment of employer-based and non-employer-based insurance costs. That would help transition things to an individual market and away from having your health insurance tied to your employment, reversing one of the many government interventions in the health insurance markets making them worse than they need to be.
Matthew Waters
Nov 16 2018 at 11:17pm
10% is way higher than actual overhead of such a program. Regular SS number is 0.5%. Disability SS is 2% since that requires fact-finding and processing. No way it would cost $500 per taxpayer to administer that program.
Thomas Sewell
Nov 17 2018 at 8:18pm
Thanks for the correction. I went looking for a welfare program which gives out cash and found 10% overhead estimated for TANF, but there are muddles and mitigations there as well.
If the program ended up looking more like SS, I agree, there would be smaller overhead, although I doubt your SS overhead numbers include the burdens imposed on people outside the government.
The overall point stands, though, as there would be additional costs which would vary between each version of the $5k program, making them not quite equivalent to each other economically as neither would cost exactly $5k/person due to the additional losses involved.
Scott Sumner
Nov 17 2018 at 11:05am
I agree that we should stop the tax subsidy for health insurance, and we should do 100 other reforms as well, to bring costs down.
Thomas Sewell
Nov 17 2018 at 8:35pm
One of the things I find most disheartening about the health care policy environment is that if I (who is really an amateur at it) can think of dozens of obvious to me ways off the top of my head to improve regulations in order to reduce waste, costs and economic mismatch, why is there so little willingness to entertain some of them even amongst supposedly ideologically compatible politicians.
Of course, the simplest remedy is to just clear out all of the related laws and regulations at the federal and local level and then start over from a clean slate with at most a couple of laws making liability clear in various circumstances, but that’s unrealistic preaching to the choir at this point.
Matthew Waters
Nov 16 2018 at 11:42pm
I think the VA has worse outcomes than Medicare, just as NHS is worse than Medicare-like regimes for other countries like Australia.
The subsidized capitalism goes even deeper than this post suggests. Several different non-free-market policies I can think of:
1. Carried interest.
2. Capital gains basis step-up on death and estate tax shelters through complex trusts. I’m okay with getting rid of the estate tax, but also get rid of the basis step-up.
3. Preference for 401(k) over IRAs, with a much higher limit. 401(k) fees are famously much higher than Vanguard and other alternatives. At best, an employer could simply be inattentive and not shop for better 401(k) plans. At worst, the employer receives part of the expense for questionably high administrative expenses.
4. The new tax bill allows private jets to be written off in full. Private jet costs should only be deducted for remote locations where commercial tickets would be difficult. Otherwise, the commercial ticket cost should be deducted.
5. Oil exploration depreciation of revenues rather than costs. Like carried interest, it makes no sense on its face.
Scott Sumner
Nov 17 2018 at 11:08am
Matthew, I now contribute to 5 different tax advantage retirement accounts—each with lots of annoying paperwork. There should be just one—say a 401k with unlimited ability to contribute.
(I contribute to IRA, Roth, SRA, 403b, 457b—and let’s not talk about my education savings account, health saving account, etc. etc.)
Craig
Nov 17 2018 at 8:45am
It is an extremely broad point that just because you see a bad argument against position X, that does not mean X is worth defending. See Yudkowsky, Reversed Stupidity Is Not Intelligence, also somewhat rephrased, from Cato Unbound
Iskander
Nov 17 2018 at 2:06pm
What does markets regulating themselves even mean?
There are some content devoid phrases out there but, to be fair, the author is just writing what people want to hear. Markets in action?
Larry
Nov 19 2018 at 8:00am
Scott: you said it brother!
Comments are closed.