Saturday, February 25, 2017

Those of us who demonize government and think it's incompetent still have a solid basis for those views (the role medicaid might have played in the opiate epidemic)

See Quinones versus Eberstadt by David Henderson.

"We have demonized government and laughed at government and called it incompetent, not paid taxes to support it. And we have a situation now, in my opinion, where--having done all that, having exalted the private sector, demonized government, what we now have is a story that the private sector has visited upon the United States of America and its people the most devastating threat to personal liberty that we know today, which is opiate addiction. And for a long time the only ones who were fighting that were government officials--coroners, jailers, cops, public health nurses, etc.
This is a statement by Sam Quinones, author of Dreamland: The True Tale of America's Opiate Epidemic. It's at the tail end of the January 23 EconTalk interview of Quinones by Russ Roberts. Yet elsewhere in the interview, Russ, drawing on Quinones's own book, said:

But you don't have $1000. You do have a Medicaid card. And the co-pay for Medicaid is $3. Which seems like a very nice, thoughtful thing. But what it means is that the taxpayer is going to cover $997 of this. The addict is going to cover $3. And then the punchline--that's interesting by itself and as an economist who has often talked about the value of cash, I can't help but note the irony that we give people Medicaid because we don't want them to have cash as a way to use it on drugs and alcohol. So there's an incredible tragedy here. So, they take the $3 co-pay; they $1000 worth of drugs; and it's worth $10,000 on the street.

I found it interesting--as Russ appeared to also--that after pointing out the huge role of government in creating or exacerbating this opioid problem, Quinones said that we demonize the government and call it incompetent. But surely this absurd policy--having taxpayers pay for people to get addicted--deserves demonization and possibly the "incompetent" label.
 I haven't had time to read Quinones's book but elsewhere I did find confirmation of the point he's making. It comes from a chilling article by Nicholas Eberstadt of the American Enterprise Institute (HT2 John Cochrane). The article is titled "Our Miserable 21st Century" Eberstadt quotes the section of Quinones's book that Russ drew on and then adds:

You may now wish to ask: What share of prime-working-age men these days are enrolled in Medicaid? According to the Census Bureau's SIPP survey (Survey of Income and Program Participation), as of 2013, over one-fifth (21 percent) of all civilian men between 25 and 55 years of age were Medicaid beneficiaries. For prime-age people not in the labor force, the share was over half (53 percent). And for un-working Anglos (non-Hispanic white men not in the labor force) of prime working age, the share enrolled in Medicaid was 48 percent. (italics in original)

Eberstadt adds:
By the way: Of the entire un-working prime-age male Anglo population in 2013, nearly three-fifths (57 percent) were reportedly collecting disability benefits from one or more government disability program in 2013. Disability checks and means-tested benefits cannot support a lavish lifestyle. But they can offer a permanent alternative to paid employment, and for growing numbers of American men, they do. The rise of these programs has coincided with the death of work for larger and larger numbers of American men not yet of retirement age. We cannot say that these programs caused the death of work for millions upon millions of younger men: What is incontrovertible, however, is that they have financed it--just as Medicaid inadvertently helped finance America's immense and increasing appetite for opioids in our new century. (italics in original)

So those of us who demonize government and think it's incompetent still have a solid basis for those views. I agree with Quinones on one thing, though: this is not a laughing matter.
 Also, unlike Quinones, I don't see how opiate addiction threatens people's liberty or how jailers and cops in the drug war apparently don't."

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