Very little about American health care is logical.

I didn’t watch today’s press conference, but reading back over the transcript I liked this discourse on the public plan, in which Obama was letting his Vulcan side show:

OBAMA: Now, the public plan, I think, is an important tool to discipline insurance companies. What we’ve said is, under our proposal, let’s have a system, the same way that federal employees do, same way that members of Congress do, where we call it an exchange, but you can call it a marketplace, where, essentially, you’ve got a whole bunch of different plans….As one of those options, for us to be able to say, here’s a public option that’s not profit-driven, that can keep down administrative costs, and that provides you good, quality care for a reasonable price as one of the options for you to choose, I think that makes sense.

QUESTION: Wouldn’t that drive private insurance out of business?

OBAMA: Why would it drive private insurance out of business? If private insurers say that the marketplace provides the best quality health care; if they tell us that they’re offering a good deal, then why is it that the government, which they say can’t run anything, suddenly is going to drive them out of business? That’s not logical.

Now, the — I think that there’s going to be some healthy debates in Congress about the shape that this takes. I think there can be some legitimate concerns on the part of private insurers that if any public plan is simply being subsidized by taxpayers endlessly that over time they can’t compete with the government just printing money, so there are going to be some I think legitimate debates to be had about how this private plan takes shape. But just conceptually, the notion that all these insurance companies who say they’re giving consumers the best possible deal, if they can’t compete against a public plan as one option, with consumers making the decision what’s the best deal, that defies logic, which is why I think you’ve seen in the polling data overwhelming support for a public plan.

Meanwhile, Ryan Grim reports that Chuck Schumer and Kent Conrad are working to blur the differences between a “public option” and a “co-op.” Ezra Klein says the compromise they’re looking at would basically amount to a public option. Under the circumstances, I think this would be a good moment for the President and leaders in the House of Representatives to step up their advocacy of a public option and criticism of the co-op concept. The way the Senate works, at least as I understand it, is that a certain number of Senators there are very in love with a “centrist” self-presentation and will insist on acquiring some kind of “major concession” from liberals before voting for a bill. The question then become, what kind of “major concession” is, in fact, minor.

Unfortunately, during the stimulus debate the Senate “centrists” actually did enormous harm to the country by curtailing aid to state government. But if these Schumer-Conrad talks progress, the “concession” they wring could more-or-less amount to just relabeling the public option as a “co-op” that would nonetheless have the essential characteristics of a public plan. On the policy merits, the issue is all buried in the details of exactly how the public plan or co-op or whatever operates. But in the political logic of the Senate, perceptions and labels matter much more. It’s not logic, but it’s life.

Richard Nixon’s racist case for abortion is getting all the play in articles about newly released Nixon tapes, but the same tapes also contain an interesting revelation about Ronald Reagan’s strong support for the “Saturday Night Massacre.” Given that Nixon’s reputation is already in the toilet, while Reagan is becoming the subject of bipartisan reverence, this Reagan factoid is probably more memorable. The massacre was an act of pure lawlessness, undertaken by Nixon for personal gain rather than any broad ideological or policy objective.

Smart growth and transit-oriented development in Arlington, Virginia (Wikimedia)

I love talking about this stuff, and now thanks to Kevin Drum I see the study I’ve been waiting for on urban land use and climate change. Kaid Benfield from the NRDC explains:

Which is a pretty long introduction to a new report that will make smart growth harder to ignore as a carbon-reducing strategy. In particular, the Center for Clean Air Policy (CCAP) released a study last Friday documenting how comprehensive application of smart growth best practices and improved transportation choices can significantly reduce transportation emissions at a cost savings to society. The report makes a strong case for investing a portion of cap-and-trade revenues in smart growth. Here are some of the key findings:

— Smart growth and smart transportation choices can reduce the amount Americans need to drive – as measured in vehicle miles traveled (VMT) – by 10 percent per capita from 2005 levels.

— A 10 percent reduction in per capita VMT would reduce annual transportation emissions by 145 million metric tons of carbon dioxide (MMTCO2) in the year 2030, equivalent to the annual emissions of about 30 million cars or 35 large coal plants.

— These reductions would equal approximately 6 percent of the 2030 greenhouse gas (GHG) reduction goal proposed in the American Clean Energy and Security Act.

The fact that these kind of moves are economically beneficial is hugely important. This is essentially greenhouse gas emissions achieved purely by using the land more efficiently. Using the land more efficiently is economically healthier than our current wasteful approach. So you’re not only reducing pollution, you’re making it possible to afford even more reductions. What’s more, this is purely a look at the transportation reductions in energy usage. In practice, intensively used land also leads to much more energy efficiency in buildings.

US Air Force personnel jog on Waikiki Beach (USAF photo)

Health care reform is clearly a complicated subject, but I think the single most compelling isolated factoid in favor of reform is the basic reality that Americans spend wildly more on health care than any other developed country and yet lead shorter lives than the residents of most developed countries. Now, clearly, there’s a bunch one could say on this subject. But one common counterargument I’ve never understood is this line from Gary Becker:

National differences in life expectancies are a highly imperfect indicator of the effectiveness of health delivery systems.for example, life styles are important contributors to health, and the US fares poorly on many life style indicators, such as incidence of overweight and obese men, women, and teenagers. To get around such problems, some analysts compare not life expectancies but survival rates from different diseases. The US health system tends to look pretty good on these comparisons.

For one thing, the US actually doesn’t look especially good on those comparisons.

But for another thing, the reality that delivering health care services is not a very effective way of delivering good health outcomes is itself a powerful point against the American system. After all, one reason we spend so much on health care is that spending a huge proportion of national income on making people healthier seems like a perfectly reasonable idea. But if it turns out that spending money on health care isn’t an effective way of promoting good health outcomes, then that means we’re doing something badly wrong. We should, it seems, be spending less on health care and more on nutritious food and gym memberships and schools (educational attainment is highly correlated with good health outcomes) and anti-poverty spending.

To put it another way, imagine a right-of-center economist arguing about foreign aid. He’d point to the fact that Africa’s gotten more aid than East Asian countries that have done much better as a reason to be skeptical that our aid programs are effective. If I turned around and tried to say “no, no, it’s not that our aid programs don’t work, it’s just that foreign aid isn’t very useful in promoting economic growth” I don’t think anyone would be very impressed by that counterargument. The legitimate reason to spend vast sums of money on health care would be to reap large health benefits. The fact that we’re not seeing large health benefits indicates that we’re doing something wrong.