State and local governments and their governors associations, mayors associations, state legislatures, corrections commissioners, and more; big and small business lobbies; and, yes, nonprofit sector lawyer-lobbyists—all three federal proxies exert nonstop pressure in favor of federal policies that pay them to administer federal business, with as few strings attached as possible, and with lots of paperwork but little real accountability for performance and results.
Pointer from Tyler Cowen. DiLulio coins the phrase “proxy-administered state” to describe how government works today. It is hard to say which is more despair-inducing in the essay–the facts or the analysis.
I have said before that there are three forms of political economy:
1. Market economy: the private sector sets goals and owns the means of production
2. Socialist: the government sets goals and owns the means of production. Think of the public school system.
3. Corporatist (or Cronyist): the government sets goals and the private sector owns the means of production. Think of Freddie Mac and Fannie Mae back when they were owned by shareholders, or think of Obamacare. These are examples of the proxy-administered state.
Speaking of Obamacare, it seems increasingly clear that it has moved the Overton Window on health care policy. You are not allowed to substitute individual responsibility for Obamacare. Instead, you must come up with a “better” system. The ground rules for any new health care system now state that responsibility for your ability to obtain health insurance ultimately rests with the Federal government.
I get the sense more that ACA gave some people a new “sustainable” pattern for their household that they became accustomed to. If so, it can be easily replaced but the degree of difficulty for clawing back an entitlement is higher than preventing it in the first place. I don’t think the average voter cares much about civics. A friend one time said to me “if the government could do something for me, what I’d really like is a lower cell phone bill.”
Much of the freedom of healthcare options was lost when I was still in my twenties, decades earlier. Alternative practitioners – either local or from other nations – were either run out of the country or otherwise told to cease and desist. Meanwhile the ability of lay people to suggest options in retail settings for alternative healthcare, was gradually being lost at the same time. What had been recognized means of herbal remedies for instance, was forcibly removed from the marketplace wherever possible, unless they could be hidden or reconfigured in remedies requiring a doctor’s prescription. It’s a shame that libertarians could not have played a more active role in preventing these supply side losses while the marketplace still offered such good options, because the fact of limited supply in so many areas of the country, is scarcely even mentioned in healthcare analysis today.
Is there any government in the world today, which isn’t a developing country, that doesn’t have government health insurance? Was the US really all that different before Obamacare?
It seems your only choices are do it right or do it poorly. The amount of government involved is irrelevant, only results. Is Singapore’s healthcare sector an example of big government (they set prices and determine availability) or small government (its 3% of GDP and most people pay for their own healthcare). Who cares, it works.
Are the trends you complaining about likely to get better or worse? Best I can tell Latinos like more government, they say so in survey after survey.
Most libertarian “victories” all cost the government money. My company pays a lot of money for STD meds for gays. Now we all get to pay for transgender surgeries.
As I enjoy pointing out, no government (maybe a handful) spends more per capita than the US. Including the tax subsidy, I suspect all the difference in price can be accounted for by our government “doing it poorly.”
Perhaps there is a somewhat more acute format (since “governments” do not do things, but are used by people as means to ends-for “purposes”):
4. Co-optive: The “goals” (objectives) and means for attaining them are determined **politically** and thus dominate private relationships* that generate production AND distribution.
* “Property” (and the concept of ownership) can both be understood as a relationship of individuals and groups to (tangible and intangible) material substance.
I believe his name is DiIulio with an I, not an L.
Many of the Republicans in congress and President Trump campaigned on a platform to repeal and replace ACA. They won elections, they have power, they are hungry for a great counter-ACA policy to sign and evangelize.
The free market health care crowd hasn’t come to a consensus on what they want to do. There are tons of good ideas. Even Arnold Kling: he wrote a book on health care, but he hasn’t been beating the drum with shovel-ready policy proposals.
If I were Trump, I’d assign Whole Foods CEO John Mackey to a health care task force.
BTW, when Trump said “insurance coverage for everyone”, that could mean anything. People misinterpret it to suggest some kind of single payer system where federal government manages all health payment. But it simply means that there will be some new government health policy and everyone will qualify.
Phase out the emoloyment anchor tax subsidy over 10 years. Legalize all catastrophic plans that cover emergency services. People who use services without insurance get liens on their entitlements. HSAs.
I like your thinking and agree with you. I’m one of those that bought an individual policy before Obamacare and haven’t had insurance since Because I am not a whiner, and looked after myself, the fact I would just as soon still pay from my own counts for nothing. I do not feel sorry for anyone that might lose what they got for free. I lost what I paid for.
I think a better term is simply ‘outsourcing’, which encompasses contractors too. The government wants a lot of things done, and finds it preferable to have them done by people other than federal government employees.
There are plenty of good reasons for this in many circumstances, but the temptation to extend unnecessarily and to revolving door corruption, pork barreling, and rent-seeking is irresistible.
Philip Klein laments: “Liberals have won the central philosophical argument, and Republicans are reduced to fighting over the mechanics.”
https://twitter.com/philipaklein/status/838997904111054848
What’s the central philosophical argument?
Perhaps libertarians must now abandon support for privatization and grant making based on efficiency concerns if the political class has learned to game such approaches perfectly.