Greg Mankiw On Pope Francis

I was going to comment on Pope Francis's recent comments on economics, but Greg Mankiw did a much better job expressing the same reaction I had:

"First, throughout history, free-market capitalism has been a great driver of economic growth, and as my colleague Ben Friedman has written, economic growth has been a great driver of a more moral society.

Second, "trickle-down" is not a theory but a pejorative used by those on the left to describe a viewpoint they oppose.  It is equivalent to those on the right referring to the "soak-the-rich" theories of the left.  It is sad to see the pope using a pejorative, rather than encouraging an open-minded discussion of opposing perspectives.

Third, as far as I know, the pope did not address the tax-exempt status of the church.  I would be eager to hear his views on that issue. Maybe he thinks the tax benefits the church receives do some good when they trickle down."

I had the exact same reaction that Mankiw had, and, as usual, Mankiw hit the nail on the head.

What Do the 1950s and 1960s Teach Us About Economic Policy?

The 1950s and 1960s economy featured a much stronger role for unions, much higher marginal tax rates on wealthy individuals, much stronger regulation, and a much higher minimum wage (in real terms). What happened?

Well, as progressive economists often tell us, unemployment was fairly low, GDP growth was fairly high, and we had much less income inequality. Is this not a total refutation of neoliberalism and supply side economics?

Perhaps, but I don't see it that way (not surprisingly). To give a bit more perspective, since that time period, union membership has fallen from somewhere around 30 to 35% of the workforce to 10 to 15% of the workforce today. Top marginal tax rates ranged from around 70 to 90% in the 50s and 60s compared to tax rates ranging from 28 to 40% over the past few decades. The minimum wage would something like $22 (that's the number I've heard) had it kept up with productivity since 1960. Instead, it is $7.25 today. Another neoliberal policy, free trade, has also been expanded greatly since the mid 20th century.

On the other hand, the Great Society was not until the 1960s and thus the welfare state was a good deal smaller for most of the 1950s and 60s than it is today. Also, while we've seen many deregulatory initiatives in recent decades, we've also seen expanding regulation in many areas. So, the direction of regulatory policy is more debatable.

Still, all things considered, our economic policy has moved in a decidedly neoliberal direction since the mid century. Despite this, as is often mentioned, there is not a noticeable improvement in economic performance during this period, but there is a large increase in income inequality. 

The way progressives (and indeed most people who look at this issue) interpret this is that neoliberalism ultimately failed to enhance productivity. I think there are two ways to interpret this:

1.) The progressive narrative that neoliberal reforms simply took place due to a political shift and failed.

2.) Another possible explanation is that neoliberal reforms were in response to a bad economic performance and did improve economic performance relative to how the economy would have performed absent the reforms.

The basic disagreement here stems around what would have happened absent any economic reforms. The progressive narrative implies that, absent the reforms, our economy would have continued performing as strongly as it had in the 1950s and 60s. The competing narrative holds that, absent any reforms, there would have been a much more significant growth slowdown than there was.

Luckily, the neoliberal revolution was not strictly an American phenomenon and indeed happened across the developed (and even developing) world. Perhaps more importantly, some countries were much more aggressive in reforming their economies than others while some did not reform at all. This offers us something close to a natural experiment. 

If the progressive narrative is correct, countries with more aggressive reforms should not see any advantage in economic growth over the countries that reformed less aggressively or didn't reform at all. If the competing narrative is correct, the more aggressive reformers should she positive (relative) results.

Scott Sumner wrote a piece in 2010 looking at this very data. He compares the GDP per capita 
(and even provides a chart) over time between various countries and here is what he finds:

"

Country	1980	1994	2008
United States	1.000	1.000	1.000
Australia	.841	.770	.837
Canada	.905	.818	.843
Britain	.688	.705	.765
France	.780	.730	.713
Germany	.803	.812	.763
Italy	.756	.754	.675
Sweden	.868	.777	.794
Switzerland	1.146	.987	.915
Asia
Hong Kong	.547	.845	.948
Japan	.732	.815	.736
Singapore	.577	.899	1.064
Latin America
Argentina	.395	.300	.309
Chile	.210	.251	.311

Note that four countries gained significantly on the United States, two were roughly stable (Australia and Japan) and the rest regressed. The four that gained were Chile, Britain, Hong Kong and Singapore. Of course, many poor countries also gained on the United States, but that's to be expected. As we will see, the relative performance of each of these economies is consistent with the view that neoliberal policies promote economic growth.

Britain: At the time Margaret Thatcher became Prime Minister in 1979, decades of statist policies had turned Britain into the sick man of Europe. The government owned the big manufacturing firms in industries such as autos and steel. The top individual MTRs on income were 83 percent on "earned income" and an eye-popping 98 percent on income from capital. Frequent labor strikes paralyzed transportation and led to garbage piling up in the streets of London. Much of the housing stock was government-owned. Britain had lagged other European economies for decades, growing far more slowly than most economies on the continent. Thatcher's reforms were among the most comprehensive in the world, and by the mid-1980s, Britain was growing faster than the other major European economies. By 2008, it had a higher per capita income than Germany, France, and Italy.

United States: The United States was doing better than Britain in 1980, but not particularly well. We had also been growing much more slowly than Europe and Japan. Unlike Britain, we were still richer than most other developed countries, and so many people viewed this convergence as partly inevitable (the catch-up from World War II) and partly reflective of the superior economic model of the Germans and Japanese. It was widely expected that Japan and Germany would eventually surpass the United States in per capita GDP. Paul Samuelson claimed in 1973 that Soviet GDP might surpass U.S. GDP as soon as 1990.5 Obviously none of this happened, and by the 1990s, the United States was growing faster than most major European economies.

Australia: A traditionally rich country whose commodity export model started to sputter in the 1970s, Australia began free-market reforms in the 1980s (under a left-wing government) and accelerated the reforms after the conservatives took power in 1996. After 1994, Australia's relative decline reversed.

Japan: Japan is just the opposite of Australia. Its free-market export model did very well in the post-war years and didn't hit a wall until about 1990. After that, domestic growth sputtered as Japan's dysfunctional government refused to reform its statist domestic economy.

Hong Kong and Singapore: These two countries top most surveys of "economic freedom" (which include size of government.) Both are in the process of becoming much richer than the United States. Some of that is due to their status as city-states. But even in larger developed economies, the population is mainly urban, and so Hong Kong's and Singapore's success is due to more than just demographics.

Canada: Canada is similar to Australia, except that it was not as statist as Australia in the earlier period, and its reforms occurred in the 1990s, when Canada began shrinking the size of government as a share of GDP, after having, in 1988, adopted free trade with the United States. These reforms were successful, as its decline relative to the United States was reversed, and Canada started catching up after 1994.

France and Germany: Both passed some reforms, but much less than Britain. They suffered a decline relative to both Britain and the United States. Note that the German data for the whole time period include the East, so their relative decline cannot be explained by the 1990 absorption of that less-productive region.

Italy: Italy instituted a few reforms, but has a significantly more statist model than most of Western Europe. Italy fell far behind Britain.

Sweden: Sweden had a bad recession in the early 1990s after having suffered decades of relative decline. It made major cuts in MTRs, privatized, and deregulated during the 1990s, and its relative performance improved after those reforms.

Switzerland: Switzerland has always been regarded as one of the most capitalist countries in Western Europe, but has also been among the least aggressive countries in terms of neoliberal reforms. That pattern would predict high levels of GDP/person, but relative decline vis-à-vis the United States And that is exactly what has occurred."

(There is more here)

The data seems to be much more in line with the neoliberal narrative than the progressive narrative. This, of course, begs another important question: if really high MTRs, really high minimum wages, and related policies hurt relative economic growth after 1980, how did the USA economy do so well with top tax rates in excess of 70% and a minimum wage over $20 in relative terms.

In my opinion, there is an often unacknowledged reality regarding economic policy and culture: a given policy could be good in one country at a certain point in time, bad in another country at a different point time, and really bad in yet another country at yet another point in time.

70% top tax rates and $22 minimum wages are the kinds of policies that are bad wherever tried. However, they would be much worse today than in the 1960s. Why?

I think a few forces since then have made these sort of economic policies go from moderately bad in the 1960s to very bad in the 2010s. One force is globalization. This is things like free trade, immigration, and the elimination of capital controls, all of which offer immense economic benefits.

However, they also make it easier for employers to find labor that is not subject to USA minimum wage laws. That could be foreign labor or (illegal) immigrant labor. It could also be machine labor.

The point is that in the 1960s, employers had fewer options when it came to labor that they valued less than the minimum wage.  That is not true today.

The same is true of taxes. In the mid 20th century, industry was not particularly mobile. People weren't particularly mobile. It was much harder to make investment or living choices based on tax regime. Still, even in in the 1950s and 1960s, there was significant investment in tax avoidance. This is made clear by the discrepancy between the high tax rates and (not so high) revenue as % of GDP. If high tax rates aren't even able to raise a lot of revenue, one wonders exactly what purpose they are serving.

Another issue is the rising role of startups. Back in the good old days (I'm told), there were a few companies that everyone worked for their entire life. They all joined the union and received a steady, stable paycheck.

Today, there is a heavy reliance on entrepreneurs and startups. New enterprises are much more difficult to startup in an environment of high taxes, high labor costs, and a large regulatory bureaucracy. Large, incumbent firms can absorb these costs more easily. An economy relying on these types of firms also involves less mobility.

An entrepreneur starting a new business is much more likely to take tax regime into account when choosing where to do business than an existing large business that already has a substantial infrastructure. In an economy that relies on the continuation of startups, tax regime matters a good deal more.

On a similar note, in the post industrial economy, people are often switching jobs. People are also competing with the entire globe when it comes to jobs. Strong labor unions were likely an inevitable casuality of economic progress.

The main point is that larger economic forces are pushing economic policy in a certain direction. In the modern world, economies with 70% top tax rates, $22 minimum wages, and powerful unions are simply not competitive economies.

People who supported these economic policies see this as a "race to the bottom". I tend to see it more as a "race to the top". Globalization has forced countries to adopt economic policies that are ultimately better for their people.

The 1950s and 1960s were something of a golden age for the American worker. However, all things considered, its a good thing that we left the economic policies of the mid 20th century in the mid 20th century.

UPDATE: I 'd also like to point out how the parameters of our debate have shifted. Even if President Obama could get his minimum wage and tax proposals through, we would be looking at a $9 minimum wage and a top tax rate around 45%. I'm not a fan of either of those proposals, but we are still looking at a minimum wage and top tax rate well below their level in the 1960s.

Republicans accepted the New Deal long ago and began trying to reform it instead of eliminate it. Democrats have done the same with regards to the (necessary) changes in economic policy that have taken place over the past 30 years.

The ACA and Market Based Health Care Reform

What exactly is the ACA?

Many on my side of the political spectrum claim that it is a government takeover of the health care system that will ultimately lead to a disasterous socialized medical system. Others on this side claim it is merely a large expansion of the federal government that will lead to all sorts of practical and unintended problems.

On the other side of the political spectrum we see some claim that the ACA is a heroic (but politically feasible) piece of legislation that reduces many of the injustices present in our current health care system. Another group claims it was a pathetic attempt to achieve a progressive goal (universal health care) largely through private entities. The latter typically support single payer health care. 

So, who's correct?

In my opinion, it is the latter group on the right who claim that the ACA's flaws lie in the practical problems that will come about with it.

Regardless, there is one thing the ACA clearly is not: market based health care reform. As a supporter of market based health reform, I have found that many ACA supporters think that I should support ACA. Indeed, a liberal friend of mine recently asked me why I oppose a bill that is so market oriented. Well, the reason, as I explained to him, is that the ACA does not move us towards market based health care. It moves us in the opposite direction.

From my point of view (an advocate of consumer based health care), there are a number of strong critiques of the ACA:

1.) The insurance regulations are far too comprehensive. If we are to have a health care system with a greater role for market incentives alongside an individual mandate, that mandate has to only mandate catastrophic coverage. I want to go into more detail about the specific benefit mandates in the future. No health care plan that mandates anything more than catastrophic insurance cannot be considered market oriented.

2.) The subsidies are a more complex issue. They don't actually interfere with the workings of the market in any major way. However, the fact that these subsidies are heavily means tested creates the unintended consequence of high implicit tax rates (IMTR). As income rises for individuals with subsidies, the subsidies are phased out which creates a disincentive to work. I support the general concept of subsidies (or tax credits) to help individuals purchase plans and finance health savings accounts (which have been impacted negatively by ACA).

3.) The Medicaid expansion is problematic as well. On top of being a means tested program that also creates higher IMTRs, Medicaid offers extremely low quality coverage. Indeed, the quality of care offered on Medicaid is simply unacceptable for a nation as wealthy as ours. Expanding the program without any major effort to improve the quality of care offered by Medicaid would actually hurt the very people the policy intends to help. One very smart blogger accurately labeled Medicaid a "humanitarian catastrophe".

4.) The employer mandate exacerbates one of the worst features in our current system: the connection between health insurance and employment. This mandate also has the unintended consequence of increasing the cost of employment which will likely lead to reductions in total employment.

5.) The tax increases are another major element that very few advocates of markets in health care would be comfortable with. This is especially true since a major tax increase is aimed at investment income which is an extremely inefficient form of taxation.

6.) I don't have a problem with IPAB per say. However, I do have a problem with the law's assumption that IPAB will save such a large sum of money. Given the nature of our political system and the limits on IPAB, it is unlikely that IPAB will achieve any major cost savings. This means that the health care law will likely add a significant amount to the national debt. This is especially true after we consider lost revenue from the deadweight loss resulting from the hikes in both IMTRs and MTRs.

Having said all of this, the ACA does do do a few things that will truly lead to a more competitive market. The health exchanges, despite their technical problems, have great potential in this respect. Indeed, if the comprehensive mandates and large amount of regulations included in the ACA get rolled back, the health exchanges could offer a path to true consumer based medicine. This would also likely require a rollback of the Medicaid expansion and elimination of the employer mandate.

All in all, I'm not a supporter of the ACA. However, I am also a political realist. Even a Republican president and congress would not be able to repeal the bill come 2017. However, the optimist in me thinks it is possible that a coalition of pragmatic Democrats who recognize that the law has many shortcomings and pragmatic Republicans who realize repeal is no longer a politically viable option may come together to fix the aforementioned problems and, perhaps, bring us something much closer to a consumer driven health care system than we had even before the ACA.

Why I Don't Like Single Payer

There are a few competing narratives surrounding the troubled rollout of the ACA. One narrative is that the problems thus far are emblematic of deep and fundamental flaws in any approach to health care reform (or virtually any other societal problem) that involves a large expansion of the state.

A differing narrative that is popular on the progressive left is that attachment to private medicine or multi payer health care financing is the underlying problem and, according to this narrative, a transition to single payer would be much smoother and efficient (example of this narrative here).

My goal here is not to dissect the differing interpretations of the implementation of the ACA. Instead, I'd like to explain why I do not support single payer, largely in response to the recent surge in discussion about transitioning to such a system.

Single payer is often defended on grounds of fairness and efficiency. Single payer, it is argued, is fairer than other health care financing systems because the state is a more egalitarian financing mechanism than the market. It is also argued that single payer is more efficient because it is able to use its large amount of bargaining power to force down prices for providers. Also, single payer health care systems do not need to put resources towards advertising, profits, etc. and can therefore run a health care system at less cost.

The empirical evidence to support such claims about the superiority of single payer is straight forward:

1.) Medicare is a single payer system. The program is popular and has lower administrative costs than private insurance.

2.) Other countries that have single payer have lower health care costs and higher life expectancies than the USA. These systems are also popular.

I'm obviously not convinced by this line of reasoning. The USA is an very large and diverse nation. Health care is a very individualized matter as well with each individual having very different health care wants and needs. Given this, it is hard to imagine the federal government's taking over of the entire financing of this sector going particularly smoothly.

Even if single payer were successful in countries like Sweden, that would hardly imply that a similar system would be successful in the USA. Sweden, for its part, seems to be moving away from a purely public health care model towards a model with a larger and more active private sector.

Then, there is the question of the empirical evidence. It is actually not clear that Medicare has lower administrative costs than private insurance. That result can only be found if you measure as a percentage of total costs. Per beneficiary, Medicare actually has higher administrative costs than private insurance. Regardless, Medicare's administrative costs don't include the many services that they outsource to other agencies (like revenue collection). They also don't include the deadweight loss inherent to the taxation used to finance Medicare.

Low administrative costs don't even necessarily indicate efficiency. It is quite possible that low administrative costs indicate underinvestment in management, fraud detection, and many other crucial services that are considered "administrative".

The large amount of bargaining power that supposedly allows these large public programs to "bargain down" prices typically have the unintended effect of eliminating competition among the sellers. Imagine a market with only one buyer. Whatever products that buyer decides not to purchase would ultimately have to go out of business due to the lack of sales. One buyer ultimately means one seller. There is no competition in this setup which means the traditional mechanism for lowering price (competition) is gone. The seller, eventually, has as much power as the single payer because neither of them has any other options. Instead of paying less for the same services, a single payer financing mechanism would eliminate the competition needed to provide lower costs and higher quality over time.

Advertising and profit are also crucial elements of any functioning market. They are hardly "wasteful costs" as advocates of single payer claim. Advertising gets crucial information to consumers and, perhaps more importantly, forces sellers to essentially figure out how their product benefits consumers (so they can advertise on that basis). Profit, for its part, is important for the signals it sends to producers and the reinvestment made possible by it.

There is a popular view that profit and advertising are somehow wasteful expenses. In fact, any system with true competition, by definition, must have a profit motive present and advertising. They are quite small expenses compared to the benefits (including cost savings) brought about by competition.

There is also the point pertaining to life expectancy. As I have pointed out in a recent post, life expectancy has little to do with the model of health care financing a country chooses. The simple fact of the matter is that health care systems don't have nearly as much effect on public as people like to believe.

When it comes to cost, single payer systems do all have lower costs levels than the extremely dysfunctional USA system. Still, somehow the British socialized medical system found a way to have higher cost growth over the last decade than even the USA. Canada, for its part, has had roughly the same amount of cost growth as the USA over the same period.

Indeed, most of the difference in health spending levels between the USA and other developed nations is a result of our excessive cost growth in the 1980s. There are competing explanations for this reality, but lack of single payer health care is not a particularly feasible one.

If anything, single payer systems should at least be much more equitable than non single payer systems. Even here, though, the evidence is not so clear. Canada, with its single payer system, actually has a steeper health-income gradient than the USA. The UK also has inequities in its (socialized) health care system.

This may seem odd at first, but one must only think of the public school system in the USA. Despite being state owned, public schools in wealthier areas are still far superior to those in less wealthy areas. There's a lot of reasons for this. Wealthier people are more sensitive to both taxes and the quality of the public sector. They are also more politically active and more willing (and able) to contribute to political candidates and are thus more politically powerful. The lesson here is that allowing the government to run industry won't end inequities within that industry. Instead, it will shift resources from economically powerful to politically powerful, and there is a lot of overlap between those two groups.

Of course, there are also the standard problems with single payer. The one size fits all model makes innovation in medicine very difficult. For all its dysfunction, our system is relatively innovative.

There are also the problems with quality that plague virtually all types of public health coverage. There are long waiting times and shortages of medical technology. The UK also has unusually bad cancer survival rates (this is also one of the few areas where we do quite well).

Our USA system is deeply dysfunctional. I'm not even necessarily arguing that our system is superior to Canada's or the UK's. I am arguing that we would be unwise to emulate these models.

Regardless of how they compare to the USA, it should be clear that they are quite dysfunctional. One of the main problems in the health care debate is the refusal by both sides to acknowledge how badly the entire developed world has handled health care.

Instead of trying to decide which health care system is the least dysfunctional, we should be asking why virtually all of the health care systems in the first world are so dysfunctional compared to other sectors in their respective economies.

Perhaps the problem is the idea that health care is "different" from other industries. Health care is different. However, the laws of economics still apply. Incentives still matter. Just like any other market, even the most intelligent central planners are not able to fix prices and allocate resources in an efficient manner. And, also just like any other market, only a decentralized, competitive system is capable of allowing the type of innovation that will ultimately lower costs and improve quality.

A single payer system would move our system in the wrong direction on all of these counts. The problems with our current system largely stem from the perverse incentives inherent to any system with as many distortions as our current system has. Implementing single payer would essentially be doubling down on the very mistakes that has brought our system to the dire state it is in today.

On Market Based Health Care

Here's Uwe Reinhardt on cost sharing in health care:

"[T]he often advanced idea that American patients should have “more skin in the game” through higher cost sharing, inducing them to shop around for cost-effective health care, so far has been about as sensible as blindfolding shoppers entering a department store in the hope that inside they can and will then shop smartly for the merchandise they seek. So far the application of this idea in practice has been as silly as it has been cruel. "

(Thanks to Austin Frakt for the reference)

This reminds me of something Paul Krugman said a while back:

"There are, however, no examples of successful health care based on the principles of the free market, for one simple reason: in health care, the free market just doesn’t work. And people who say that the market is the answer are flying in the face of both theory and overwhelming evidence."

I can think of a few real world examples of more or less free market (or consumer based) health care:

1.) In the USA, cosmetic type surgeries like Lasik Eye Surgery (look here). Results seem to be fairly positive.

2.) Abroad, Singapore and, to a lesser extent, Switzerland use significant amounts of cost sharing. These systems aren't exactly "market oriented", but consumers have a lot of "skin in the game" compared to other systems (including our own system). The results (here and here). On the whole, results here seem to be fairly positive as well.

Obviously, just because a certain policy is good in cosmetic surgery or small, wealthy, and healthy countries does not mean it is right for an entire nation like the USA for all types of care. However, the limited evidence in "free market" medicine seems to be pretty favorable. The problem is that it is limited.

Still, it's a far cry from "no examples of success", as Krugman claims. 

Granted, there is a lot more evidence from non consumer based health care systems like Canadian single payer, UK socialized medicine, or even USA multi payer because we have a lot more experience with these systems. However, the evidence here seems to be quite negative for all these systems. Indeed, the only way you can paint a remotely positive picture of virtually any health care system in the developed world (excluding Switzerland and Singapore) is by comparing to a more dysfunctional system (typically the USA).

The evidence on free market health care is, admittedly, very limited, but it also is favorable. Compared to the overwhelming evidence of failure in every type of non consumer based health care system, it seems like it may be worth pursuing.

Universal Health Care and Life Expectancy

It is very hard to come by good measures to compare health care systems. We can compare costs fairly easily, but it is much more difficult to compare the actual quality of health care offered. Instead of acknowledging this reality or trying to find better measures, commentators oftentimes use measures that tell us very little about the actual quality of a nation's health care.

The classic example of this is the oft repeated claim that "other countries with nationalized health care have lower prices and higher life expectancy than the USA". This is an entirely true statement, but the implication is that nationalized health care (or other forms of universal health care) is the cause of lower prices and higher life expectancy. 

The relative prices of different health care systems is a point I'll get to in a later post as it is quite complex. However, the claim that these systems increase life expectancy is an example of intellectual laziness. Life expectancy is impacted by many factors that have little to nothing to do with a nation's health care system. This is a point that Avik Roy made in a recent post, drawing on research from Robert Ohsfeldt and John Schneider. After controlling for international differences in car accidents and homicides, they found that the USA actually has the highest life expectancy even among developed nations.

Aaron Carroll also comments with a contrary view. Carroll points out, accurately, that people in the USA still lag in life expectancy after age 65. This metric should be less influenced by premature deaths from homicide and car accidents. However, as Carroll points out, people older than 65 in the USA are on a single payer system: Medicare. Some are also on Medicaid. So, the USA lagging in life expectancy above 65 is not exactly a point in nationalized health care's favor, as this is a group that is on a form of nationalized health care.

I found this old post from Tino Sanandaji comparing Sweden's life expectancy over time with the USA to be quite interesting as well. Here's an excerpt:

"Medicare was introduced 1965 in the US. Public health coverage for the elderly existed by 1950 in Sweden, but full universal coverage dates to 1955 in Sweden (a public health insurance was founded in 1891, and public municipal public health existed for even longer).

In 1950, before Medicare, and before Universal coverage in Sweden the difference was +2.6 at birth and +0.3 at 65. In 2001-2005 the difference between the Sweden and US was +2.7 at birth and +0.3years at 65. Identical!

First, regarding the life expectancy at birth we can note that 50 years of different health policy, labor mark policy, welfare state coverage seems to have had zero effect on total outcome.

Second the pattern of large differences at birth but small differences at 65 existed well before the introduction of Medicare in the U.S, refuting Yglesias and Krugmans automatic attribution of differences in outcomes to the differences to policy.

It suggests a shallow understanding of the world to attribute every national difference to policy. Reality is more complex than that. Health outcomes in Europe and the U.S differ for other reasons, especially having to do with lifestyle, including auto accidents, the murder rate, smoking, diet, and demographic differences."

The key takeaway here is that health policy seems to have very little effect on actual measures of public health. This is similar to the point I was trying to make with regards to the Oregon Medicaid study.

I'm not a supporter of a single payer or nationalized health care system in the USA. One of the main reasons is the lack of evidence that such a system would bring about large benefits. Even the most intelligent supporters of single payer are often guilty of falling back on this very weak argument on life expectancy (or a similarly weak argument on infant mortality), and that does not speak well for single payer.