• A bittersweet column

    While this blog could not be happier about David Leonhardt’s promotion at the NYT (there’s no one more deserving), it means that he will not be writing his regular column any longer. That means we will not get to read pieces like this:

    [K]nowledge tends to come with caveats and nuances. Economic truths may not rise to the level of two plus two equals four, but they are not so different from the knowledge that the earth is round or that smoking causes cancer.

    The earth is not perfectly round, of course. Some smokers will never get cancer, while most cancer is not caused by smoking. Yet in the ways that matter most, the earth is still round, and smoking does cause cancer. Both of these facts are illustrative in another way, too: seemingly smart people spent decades denying them.

    When it comes to economics, we know that a market economy with a significant government role is the only proven model of success. The United States has outgrown Europe partly because of our greater comfort with market forces. China and India boomed after allowing more of a market economy. On the other hand, unencumbered market forces often lead to disaster, as 1929 and 2008 made clear…

    We know that the federal government has promised more benefits than it can currently afford. The only way out of this problem involves some combination of tax increases and cuts to MedicareSocial Security and the military. Anyone who won’t get specific about which ones they favor is not a fiscal conservative.

    We know this country spends vastly more on health care than any other country — about 75 percent more per person than other rich countries — without getting vastly better results. The waste in our medical system offers the best chance to reduce the deficit without harming our living standards.

    We know the planet is getting hotter. Last year tied for the warmest on record, and the 10 hottest have all occurred since 1998. The resulting risks, economic and otherwise, may beeven more serious than the risks from the deficit, but receive far less attention in Washington. (And climate worriers do not need to be so skittish about making the connection between heat waves and the larger trend. The thing about global warming is that it warms the globe.)

    Somehow, David manages to make these points in a way that cuts through much of the political haze that seems to permeate our debate. He does it without raising his voice, and he does it without managing to scare off half the country. It’s a skill that’s far too rare these days, and one we desperately need.

    David makes a point towards the end of the column that it worth highlighting (emphasis mine):

    The place where economic knowledge gets murkier is how to best deal with many of our biggest problems.

    We cannot know, for example, what would happen if the government raised taxes to cut the deficit. A moderate increase seems unlikely to do much damage to economic growth, given that the increases by George H. W. Bush and Bill Clinton did not prevent the 1990s boom — and that George W. Bush’s tax cuts were followed by mediocre growth. All things equal, though, tax increases do not lift growth.

    Likewise, we do not know precisely how to regulate Wall Street so that it will remain the global financial capital without also being a drain on our national resources. We do not know whether the most promising attack on climate change involves a carbon tax or more money for clean energy research. We don’t know how much medical costs would fall if people had to pay more out of pocket, as conservatives advocate, or how much costs would fall if Medicare tried to crack down on dubious care, as the Obama administration prefers.

    The real problem with so many of these issues is that the political system is not even trying to find solutions.

    One of the reasons I went into health services research is that highlighted sentence. We don’t know for sure how these things might work out, but these are answerable questions. Carefully designed studies can tell us how these policies will work. The problem is that we don’t do them often enough, and we don’t believe the results when we do.

    I’ve said this many times, but I think it’s worth repeating: I hold the beliefs I do about the US health care system because I think they are the ones best supported by evidence. If tomorrow, you conduct and show me a well designed randomized controlled trial that proves that decreased insurance regulation and increased cost-sharing leads to decreased spending and good outcomes in a generalizable population, I’ll change my mind on that. If you show me such a study that proves Medicaid is bad for people, I’ll change my mind on that. I will. I’ve done it before.

    But you have to agree to the same. If a study proves something that contradicts your worldview, you still have to accept the results. It’s how we build a better system, based on science.

    Unfortunately, we don’t do those kinds of studies. In fact, the government seems hellbent on cutting off funding for the very groups that might pay for them. Instead, we choose to believe in political talking points rather than sound evidence. We, and our health care system, are poorer for that.

    And, we are poorer for the loss of David Leonhard’t columns to remind us of all of this.

     

    Share
    Comments closed
     
    • This is certainly a rational plea for making decisions based on facts and results that have proven to work. But the country is in the grips of another wave of Jacksonian Populism that values “common sense” and eschews experts. It was logic like this that forced the US to endure almost 75 years without any national bank resulting in multiple panics.

    • I love how you put it in the 3rd to last paragraph. I try to explain to people I meet that regarding health policy, my allegiance does not lie with an ideology; it lies with particular outcomes. If current evidence showed that deregulation and more cost sharing would result in those outcomes, I’d be all over that approach.

    • The Tea Party folks are talking about NEVER raising the debt ceiling, which means cutting $1.6 Trillion THIS YEAR. 40% of the budget. Right now.

      That will certainly affect the availability of funds for all kinds of science.

    • Our nation was fine for 200 years with a budget of 2.something trillion- our nation was fine with a budget of 2.something trillion 5 years ago. Why would it collapse and my grandma eat dogfood if it returned to that budget today? Are federally funded studies of penis size in gays in NY that vital? Was building a footpath bridge right next to a road with sidewalks near my house really that vital? Is studying prostitutes in China vital? Government should return to the bloated size it was under the awful spendomatic W, and then figure out where the next cuts come from.