Universal healthcare and market-based systems aren't mutually exclusive

An op-ed published last week in the New York Times laments Americans' decline in support for government involvement in the redistribution of wealth - or, as the Times author Thomas Edsall calls it, ‘sharing’. Edsall analyses a bunch of polls throughout the article, but what he finds troubling I find to be good common sense. For example, most Americans aren't incredibly trusting of their government:

Even worse for Democrats, the Saez paper found that “information about inequality also makes respondents trust government less,” decreasing “by nearly twenty percent the share of respondents who ‘trust government’ most of the time:”

Smart thinking.

Furthermore, most Americans aren’t convinced that Obamacare is going to be the shining, efficient, cheaper, all-inclusive beacon of hope it was promised to be:

An earlier New York Times poll, conducted in December 2013, found that 52 percent of those surveyed believed that the Affordable Care Act would increase their medical costs; 14 percent said it would reduce costs. Thirty-six percent believed that Obamacare would worsen the quality of health care compared to 17 percent who thought it would improve it.

Also probably wise.

On the whole Edsall appears to understand people’s perceptions of government care (to my relief and his dismay) quite well – except for in one area.

Esdall claims the “most dramatic” change in public opinion has been people’s perception of the ‘right’ to healthcare. He cites the two Gallup polls in an attempt to claim that majority support for guaranteed access to health coverage has dropped radically over the past six years:

The erosion of the belief in health care as a government-protected right is perhaps the most dramatic reflection of these trends. In 2006, by a margin of more than two to one, 69-28, those surveyed by Gallup said that the federal government should guarantee health care coverage for all citizens of the United States. By late 2014, however, Gallup found that this percentage had fallen 24 points to 45 percent, while the percentage of respondents who said health care is not a federal responsibility nearly doubled to 52 percent.

But Esdall isn’t comparing apples with apples. The belief that in a developed society everyone should have access to basic healthcare provisions is not the same as believing that healthcare is a federal responsibility – especially in the United States.

The debate is not – and has not been for a long time – whether or not people should have access to healthcare, but rather how that care should be provided. What kind of delivery of healthcare will create the cheapest prices and best outcomes, and what safety net for those at the bottom will provide the most comprehensive care?

There is huge demand in the States for healthcare reform, and most people want this reform to focus on cheaper access to care. But that can be achieved without fully handing healthcare provision over to the federal government or adopting something that resembles the NHS.

Both the US and the UK should be looking to countries that rank highest for healthcare provisions internationally, which have almost all settled on systems where the central government funds healthcare but does not directly provide healthcare.  The Netherlands, Denmark, Switzerland, and Germany all have healthy relationships with private companies, ranging from insurance companies and charities, that provide better outcomes than those in the UK and in a cheaper, more efficient manner than in the US.

Support for universal access to healthcare and support for market mechanisms in healthcare are not mutually exclusive; there's plenty of evidence to suggest a combination of the two creates the best healthcare systems in the world.

No, John is not responsible for gender gaps

Gender baiting has launched again in the United States, but this time it’s personal. Quite literally – the oppressors’ names are John. From The New York Times:

Fewer large companies are run by women than by men named John, a sure indicator that the glass ceiling remains firmly in place in corporate America.

Among chief executives of S.&P. 1500 firms, for each woman, there are four men named John, Robert, William or James. We’re calling this ratio the Glass Ceiling Index, and an index value above one means that Jims, Bobs, Jacks and Bills — combined — outnumber the total number of women, including every women’s name, from Abby to Zara. Thus we score chief executive officers of large firms as having an index score of 4.0.

The NYT didn’t stop there; the article goes on to use its new Glass Ceiling Index to compare political successes, too:

I have to hand it to the NYT - this is an excellent propaganda piece. Determining the success and advancement of women in their careers to how those numbers compare to men named John, Robert, James, and William gives you some pretty damning results.

Left-leaner’s will find any opportunity they can to blame the sexism and discrimination that is still rooted on our society on employers and business culture; that way they can legislate quotas and pay structures across the board, and at least create the illusion, through force, that equality exists.

But evidence, even from the NYT's own sources, suggests that employers are not the problem.

The NYT's report was “inspired by a recent Ernst & Young report, which computed analogous numbers for board directors…for every one woman, there were 1.03 Jameses, Roberts, Johns and Williams — combined — serving on the boards of S.&P. 1500 companies.”

Lets look at that report a bit closer. It is the case that the number of male directors at S&P 1500 companies is hugely disproportionate to the number of female directors (84%/16%), but there is also evidence that the tide is changing. The graph below details that while far more men hold directorships, they also tend to be significantly older in age; 49% of female directors at these companies are under the age of 60 (compared to only 33%) of men, and 31% of male directors are over the age of 68 (compared to only 11% of women).

Like many other occupations, a lot of perceived gender gaps are going through transitional periods; as women become more educated than men, we start to see changes in occupation breakdowns (but it’s not in the interest of gender-baiters to report it).

My colleague Ben has recently blogged on a paper that found if you control for a person’s background and length of time in the work force, “being female increases the chance of becoming CEO. Hence, the unconditional gender pay gap and job-rank differences are primarily attributable to female executives exiting at higher rates than men in an occupation where survival is rewarded with promotion and higher compensation.”

It’s not employers and it’s not corporate culture that’s holding women back; the reality is that women are making different choices than men. Many of them have to do with family planning, but many of them come down to different goals and ambitions.

Examples include both political and career ambitions. Women and men “win elections at equal rates, raise comparable amounts of money, and receive similar media attention” yet very few women are wanting or willing to run for pubic office. Research conducted in 2012 found that millennial women "just aren't very interested in being the top executives of high-profile companies." Of all the women aged 22-33 polled, only 15% actively wanted to lead a large, prominent business one day.

The NYT can use the Johns and Jameses of the world to paint political and market systems as sexist all they want, but their provocative Index completely misses the point. Women are choosing not to take their careers as far as they can go. And that's okay - if that choice makes them happy and gives them opportunity to peruse other meaningful things. But the real glass ceiling for women is being held up society at large, which often compels women from a young age to make different decisions than men.

Are women being educated about their career options properly? Do they feel supported to have kids (or not have kids) on their own terms? These are the issues that are really holding women back. If we actually want to address gender gaps in the work place, let's let John get on with his job while we tackle our deeply entrenched, and often bias, cultural norms.

But *which* right on and trendy thing should I be doing?

One of those lovely little conundrums is raising its head over in the right on and trendy food movement at present. The problem being, well, which part of being right on and trendy should people sign up to? This has actually got to the point that there's a New York Times opinion piece imploring people to, umm, well, ditch one principle in favour of another:

And yet, if you look closer, there’s a host of reasons sustainable food has taken root here in central Montana. Many farmers are the third or fourth generation on their land, and they’d like to leave it in good shape for their kids. Having grappled with the industrial agriculture model for decades, they understand its problems better than most of us. Indeed, their communities have been fighting corporate power since their grandparents formed cooperative wheat pools back in the 1920s.

For the food movement to have a serious impact on the issues that matter — climate change, the average American diet, rural development — these heartland communities need to be involved. The good news is, in several pockets of farm country, they already are.

"Sustainable" food here means organic. Oh, and small producer: you know, one who cannot get economies of scale because they're running too few acres. but, you know, if people want to produce this way, live on the pittance they can earn in this manner, good luck to them and all who sail with them. and if people want to buy their produce similarly good luck. However, there's something of a problem:

But just as these rural efforts started gaining steam, an unfortunate thing happened to the urban food movement: It went local. Hyperlocal. Ironically, conscientious consumers who ought to be the staunchest allies of these farmers are taking pledges not to buy from them, and to eat only food produced within 100 miles of home.

Montana has perhaps three people in addition to all those cows. And it's a lot more than 100 miles away from any of the hipsters who are interested in small scale organic farming. And those hipsters are all eating local. Which is, don't you think, just so lovely a problem?

Those urban aesthestes are simply missing the point of farming altogether. Which is that it's a land hungry occupation (organic even more so than conventional) so it makes great sense to do that work where there's no people. Farming right by the big cities of the coasts, where land is hugely expensive (because there's lots of people in those big cities) is simply not a sensible manner of using the resources available.

Just so much fun to see the fashionable being hoist on their own petard really.