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On the other hand, this point Megan McArdle made yesterday is something I wish more people would pay attention to:
What would happen if we took all the money we’re plowing into the middle class [by subsidizing health insurance through the tax code], and invested heavily in a visting nurse’s service? I know that I was a lot more religious about monitoring my peak flows when the nice nurse from the insurance company called to badger me.
There are two ways of discouraging people from doing something they would otherwise want to do. One is to make it expensive. The other is to make it complicated. If something is hard to figure out, and requires completing many different individual actions at different times in different places, large numbers of people will fail to take advantage of it. (See, for example, the “mail-in rebate” scam.)
Liberals in the US spend a lot of time worrying about how the government can make things more affordable, and far too little time thinking about how the government can make things less of a pain in the ass. In fact, the momentum in the health care bill so far has essentially gone in the opposite direction: while doing a reasonable job of making insurance more affordable for the poor and sick, Democrats have made it more and more complicated. Every time Republicans or mindless centrists raised an objection, Democrats have responded by creating some complicated workaround. The result is a bill that, while it fixes many of the problems with the status quo, is also so complex that people are afraid they won’t be able to figure it out, and will have to waste a lot of time and mental energy getting the goods the bill promises them. And even when they get the goods, they’ll have to worry that they missed some provision they should have taken advantage of, that would have gotten them a better deal.
However, a lot of the initiatives that do take the form Megan is recommending — sending someone around to your house to check up on things — are routinely denounced as elements of a “nanny state”. I’ve never understood what people dislike about the idea of a nanny state. I have a nanny, and it’s fantastic. She takes care of all kinds of routine stuff that I don’t want to bother with — getting the kids to clean up their toys, cooking their lunches so I can pack them for school the next day — and when I move back to the West and can’t afford one anymore, I’ll miss her terribly.
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