Friday grab bag: Breaking the jobs / health insurance link

Plus state capacity and challenge trials

I really enjoyed Jennifer Pahlka’s essay on why we have hard-working, talented, and well-meaning public servants doing the wrong jobs — focused on box-checking and compliance rather than achieving policy goals. But every time I read something from Pahlka, I get worried that she’s almost too convincing. That people are going to read her take and think “yeah, that’s obviously right, I agree with that, who wouldn’t agree with that?”

It’s important to acknowledge, at some level, that people actually do have reasons for not wanting to adopt ideas that would make the government more effective.

The main reason is that there’s a lot of substantive disagreement about what we would like the government to be effective at doing. Donald Trump, for example, has lots of ideas that I think are crazy or stupid or nonsensical or ridiculous. But he also has a handful of ideas that I think are just wrong and bad. Investing a large amount of resources in rounding up long-resident illegal immigrants seems to me like a big waste of time and money. I wouldn’t do that if I were president. But Trump, by all accounts, is really fired-up about every aspect of the immigration puzzle. He wants to cut legal immigration, and secure the border, and step up interior enforcement all simultaneously. In a country with a lot of “state capacity,” he would be able to accomplish that if he wins an election.

To me, this is an okay trade. I would rather have a government that is able to “get things done” on the basis of priorities set by democratically elected officials, even though roughly half the time the officials who win are the ones I didn’t vote for. But it is a very real trade. The first Trump administration genuinely did not accomplish very much, and part of the reason is accomplished so little is the same structure of delay and vetocracy that make it hard to build a zero-carbon electricity grid.

And to be clear, this isn’t a point about fairness.

The point is that it’s literally not possible to increase capacity to do things, with the proviso that it has to be only good things. The proceduralism that tries to guarantee “only good things” is precisely the thing that makes it impossible to do anything. You need to be willing to take that risk. I’m sure Pahlka knows all this, and there is a lot of merit to her approach of trying to be agreeable about it. But I want to genuinely do the thing, which means being eyes-open about the risk.

Other recommendations:

• Darrell Owens on affordability requirements.

• Dan Drezner on existential risk.

• Ryan Puzycki on the City of Yes.

• Hannah Ritchie on Moloch traps.

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This week in good news, I am glad to see the federal government rescheduling marijuana, and I am thrilled to learn that young Americans’ are seeing their wealth increase at an unprecedented rate so they will be able to afford to get high. The White House is doing some useful permitting reform stuff, though I personally would go further. Rents for new leases continue to fall. And America is making polysilicon again, which is important.

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Comment of the week is Travis Quigley doing some (definitely allowable) self-promotion:

This is a bit self-promoting — I hope of an allowable kind! — but, since Matt was on the challenge trial beat during the pre-vaccine Covid days, I thought Slow Boring readers might be interested in this paper that I recently published in the philosophy journal Bioethics. (I'm usually just a reader, but one of my only comments was a cool exchange with one of the founders of One Day Sooner, which actually partly inspired this.) Basically, I argue that current bioethical skepticism about risky challenge trials (and other instances of what I call "medical effective altruism") is philosophically unfounded, and rests at best on conservatism about institutional credibility and overblown worries about informed consent. This link will go to a paywalled version (anyone with an academic log in should have access), but I'd be happy to email a copy to anyone else who'd be interested, or just chat about the topic, which I think is pretty important going forward even though it didn't turn out to be a huge deal in the initial wave of Covid vaccines (because the mRNA vaccines came around so quickly anyway).

I love this paper and will just repeat one snappy quote: “if soldiers can be heroes, why can't research volunteers?”

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Now for this week’s reader column, Mo Diddly asks:

In many normie conversations I’ve had (across a wide political spectrum), it seems like there is a truly bipartisan appetite for decoupling health insurance from employment. It’s such an easy sell for both right and left, why is this never on the table from any actual politicians, Democrats or Republicans?

This question reminded me of how much I miss the days when politics was boring and a larger share of political journalism was done by tedious people for an audience that was genuinely curious about why certain things work the way they do in the government. The issue here is that while at a high level of abstraction it’s easy to get people to agree that having the government heavily subsidize job-linked health insurance is a non-optimal approach to healthcare policy, that doesn’t specify a unique alternative system. Every possible alternative that you could come up with has some downsides relative to others. And in a highly polarized climate, it is hard to forge win-win compromises on such a high profile and potentially explosive issue.

I used to spend a lot of time talking to health policy experts and reading their PDFs and attending their think tank events. I’m fairly certain that if you locked Michael Cannon from Cato and his staff in a room with the Center for American Progress health policy team and told them they had to come up with a joint proposal that everyone in the room agreed was better than the status quo before they could go home to their families, they could do it. They could probably actually write down more than one plan that they would broadly agree is better than the status quo. But whatever they came up with wouldn’t be better for every specific individual and interest group in American society. And a lot of the upside would be pretty marginal, like “healthy people who might hypothetically fall ill and genuinely need medical treatment will benefit from slightly lower levels of utilization by hypochondriacs if they do happen to get sick.” Or “you could save a few hours worth of annoying paperwork before quitting your day job to launch a Substack.”