More on Social Policy and Comparisons
Mostly about how not to do it.
I have to confess that I made a mistake. That mistake was being sucked into reading Brett Stephens’ column in the NYT, Biden’s Plan Promises Permanent Decline. I mean, with that kind of prediction, how could I not be intrigued?
I will start with two legitimate points that Stephens makes.
First, he makes a common, and legitimate, conservative point that there may be unintended consequences and costs for these programs. This is undoubtedly true and is often a caution that prudent conservatives offer off up as a consideration about the limits of human reason and its limited ability to foresee the future. Of course, it is also often a seemingly wise admonition that has the result of nothing happening, which is often the conservative position to begin with. As such, it is often difficult to decide whether this proclivity to worry about the unforeseen is wisdom or just a handy excuse to forestall change. Although I will allow that regardless of motivation, it is a thought worthy of some level of consideration.
Second, he notes that once social services are expanded, taking them away will be very difficult for Republicans to accomplish down the road. This is certainly true (see, e.g., “repeal and replace” efforts and the ACA as a recent historical manifestation of this fact). But, it does raise a question that contradicts the thesis of the title (and of the piece): that these proposed changes are a net negative for the country. Why is it that changes that conservatives allege will lead to ruin (such as, in the past, Social Security, Medicare, and the ACA, to name three) end up not only not leading to ruin, but end up becoming so popular that getting rid of them becomes politically impossible?
Could it be that these predictions of doom are inaccurate?
To quote a former Republican President, “‘Fool me once, shame on…shame on you. Fool me—you can’t get fooled again!“
Setting aside the track record of conservative doom and gloom in these matter, let’s look at the content of Stephens’ column, which is an attempt to make some comparative points.
He starts with an anecdote:
Years ago, Alexis Tsipras, the party leader of Greece’s Coalition of the Radical Left, surprised me with a question. “Here in the United States,” the soon-to-be prime minister asked me over breakfast in New York, “why do you not have this phenomenon of passing money under the table?”
The subject was health care. Greece has a public health care system that, in theory, guarantees its citizens access to necessary medical care.
Practice, however, is another matter. Patients in Greek public hospitals, Tsipras explained, would first have to slip a doctor “an envelope with a certain amount of money” before they could expect to get treatment. The government, he added, underpaid its doctors and then looked the other way as they topped up their income with bribes.
Now, as a comparativist with some passing knowledge of Greek politics (although I am no expert), my first thought upon reading this was, “Greece has a known corruption problem, doesn’t it?”
Indeed it does.
I looked at Transparency International’s Corruption Perception Index and noted that, in fact, Greece doesn’t score all that well, especially for a European democracy. Greece scored a 50/100, which ranked it 59 out of 180 cases. Indeed, it had improved its score by 14 points since 2012. So, Greece doesn’t score well in this realm now and it scored worse “years ago” (probably circa 2015, based on how it is described above).
For what it is worth, if you look at the CPI list, the US is tied for 25th (with Chile) with a score of 67. The number one slot is a tie between Denmark and New Zealand with a score of 88. Note they both have universal health care, as do almost all, if not all, of the countries that rank ahead of the US (there are a couple of cases I am not sure how to classify in that list). The average score for Western Europe and the EU is 66 (the highest regional average in the world).
So, while Stephens is right to note the following (the basic thesis of his piece), there is precisely zero usefulness in equating Greek problems with corruption to the presence of universal health care:
Take a close look at any country or locality in which the government offers allegedly free or highly subsidized goods and you’ll usually discover that there’s a catch.
But, of course, there is a catch (defined as some imperfection or cost) in any choice made. There is a “catch” for the current US system of health care, just as there is with any other system. There is a “catch” to full market solutions and a catch to government intervention in the market. Governance is about balancing the catches.
The true main problem with all of Stephens’ evidence is that he identifies a “catch” without asking whether the catch in his example is better, worse, or the same as the catches in the US.
He provides, for example, a golden oldie: wait times and universal health care:
In Britain, the National Health Service is a source of pride. Except that, even before the pandemic, one in six patients faced wait times of more than 18 weeks for routine treatment.
This one always gets trotted out, but first, note that the NHS is just one version of universal health care among many (and is almost certainly not the type that will come to the US if one ever does). But, here’s a catch that citizens of the UK don’t deal with: bankruptcies due to medical costs (to name one).
Beyond that, I would like to know a) what are wait times for similar procedures in the US? And, more importantly, b) what is the percentage of citizen access to comparable procedures across the two countries? (I would also like to know what wait times are in other systems, of which there are several different types across a host of countries to compare).
Above all else, in terms of slam-dunk, oh my gosh! kinds of stats, is noting that 16.7% (one in six) of patients face long waits supposed to be impressive?
He cites other examples:
France’s subsidized day care is, by all accounts, fantastic for working parents who get their children into it. Except there’s a perpetual shortage of slots. In Sweden, a raft of laws protects tenants from excessively high rent. Except wait times for apartments can be as long as 20 years.
Ok, maybe the shortages of slots and wait lists for apartments make those systems not worth pursuing. Or maybe there are fixes that are needed. But you can’t just assert these problems without trying to put in context what isn’t working in the US. In other words, is the US system of day care sufficiently superior to France’s for us to dismiss it as a model? Perhaps the answer is yes, but you can’t get there by just point to a single negative example of their system.
The entire column is made up of this kind of “argument.”
Look, I am not saying that everything we do in the US is horrible and that everyone else does it perfectly and all we have to do is be like X. But it is also true that there are successful social policies in other places that are worth closer examination. I am especially noting that it is poor rhetoric, and even worse social science, to point out a problem or two about something else without providing actual comparisons.
It may be true, for example, that the car you are thinking of buying gets worse gas mileage than you would like. But if the alternative is the old car with a busted transmission, the gas mileage issue becomes more than a manageable objection. I know that is a clearly extreme example, but the point is: it takes data from both sides of the comparison to allow for an actual assessment. Approaches like Stephens’ are intended to make the reader assume only the best about the US contetx while being turned off by his litany of problems in those places with all those terrible social programs.
All policies have up sides and down sides, and an honest assessment has to be willing to take it all into account.
And look, while it is clearly the case that I am sympathetic to increased spending on social policies of the type under discussion, I am more than amenable to a real evidence-based argument as to why we should, or should not, do X, Y, or Z.
Back to Stephens:
What will America get for the money? The progressive bet is that it will be things Americans like and want to keep, like universal pre-K and paid parental leave. Progressives also bet Americans won’t mind that the Jeff Bezoses and Elon Musks of the world will pay for all of it.
Maybe those bets will pay off. And conservatives would be foolish to dismiss the sheer political appeal of the progressive pitch. But before the U.S. takes this leap into a full-blown American social-welfare state, moderates in Congress like Senator Joe Manchin or Representative Jim Costa ought to ask: What’s the catch?
All well and good. But they should also ask what the catch is for not engaging in the spending. Stephens pretends like the status quo has no cost.
His conclusion, which circles back to the title is, well, drivel:
But investments like these, once made, are almost never reversed. The spending will become permanent. Beyond the gargantuan cost, Congress should think very hard about the real catch: transforming America into a kinder, gentler place of permanent decline.
He makes no case for “permanent decline” in the piece. None. In fact, the word only appears in this paragraph and in the title. He implies possible negative outcomes, but there is no systematic argument constructed.
I assume his point is that the sum total of all the bad things he has cherry-picked about other countries will lead to US decline, but he doesn’t actually make that case. That there is a catch for everything is not proof of decline.
The closet he comes is stuff like this:
The real catch is that massive government spending has hidden costs that are difficult to capture in numbers alone.
Take another look at Europe. Why does R&D spending in the European Union persistently lag that in the U.S., to say nothing of places like Japan and South Korea?
This is where I note that Japan and South both have universal healthcare and extensive social safety nets, especially Japan. As such, none of this makes sense in terms of staking out a coherent claim.
Ultimately, I feel like I have read some version of this column my entire life and I am to the point of being utterly tired out by the poor argumentation of it all.