Economics, Model, Politics

Minimum Standards or Broad Access?

[5-minute read]

There are two sides to every story. Zoning and maximum occupancy regulations are exclusionary and drive up the price of housing. They are also necessary to prevent exploitative landlords from leaving their tenants in squalor. Catastrophic health insurance plans leave patients uncovered for many of the services they might need. They’re also often the only plans that are rational for younger people to buy.

Where you come down on either of these – or any similar cases where there’s a clear trade-off between maximum access and minimum standards – is probably heavily dependent on your situation. If you’re an American millennial without an employer-provided or parental health care plan, you’re probably quite incensed about the lack of catastrophic health care insurance. For healthy young adults, those plans were an excellent deal.

Similarly, workaholics in the Bay Area sometimes want to be able to stuff a house full to the bursting to save on rent. If you’re never going to be home, regulations around the number of square feet per bed feel incredibly onerous.

I like to point out that regulation is a trade-off. Unfortunately (or perhaps fortunately), it’s a trade-off made at the middle. People in the long probability tails – those who are far from the median when it comes to income or risk-tolerance often feel left out by any of the trade-offs made by the majority. This is an almost inevitable side-effect of trade-offs that I rarely see mentioned.

If you have health problems for which Obamacare didn’t mandate coverage, then you might find yourself wishing that the coverage requirements were even more expansive. If you find yourself really hating the illegal AirBnB you’re living in with twelve other programmers, you might wish that the city’s rental enforcement unit was a bit more on their game.

Most articles about people on the extremes leave out the context and leave out the satisfied middle. They don’t say “this is the best trade-off we could get, but it’s still imperfect and it still hurts people”. They say breathlessly “look at this one person hurt by a policy, the policy hurts people and is bad; the people who advocate for it are evil.”

It’s understandable to leave out the middle in the search of a better story. The problem arises when you leave out the middle and then claim all advocates are evil for failing to care about the fringes. Because most of the time, no one is being evil.

The young people skipping out on coverage because it’s not worth it for them aren’t shirking a duty. They’re making the best of their limited finances, ravaged by a tough entry-level job market and expensive university education. The NIMBYs who fight against any change to local building codes that might make housing more affordable are over-leveraged on their houses and might end up underwater if prices fall at all.

Even appeals to principles don’t do much good in situations like this. You can say “no one should live in squalor”, but that might run right up against “everyone should be able to afford a place to live”. It can be that there simply isn’t enough housing supply in desirable cities to comfortably accommodate everyone who wants to live there – and the only way to change that involves higher direct or indirect taxes (here an indirect tax might be something like requiring 15% of new rental stock to be “affordable”, which raises the price of other rental stock to compensate), taxes that will exclude yet another group of people.

When it comes to healthcare in America, you can say “young people shouldn’t be priced out of the market”, but this really does compete with “old people shouldn’t be priced out of the market” or “pre-existing conditions shouldn’t be grounds for coverage to be denied”.

The non-American way of doing healthcare comes with its own country specific trade-offs. In Germany, if you switch from the public plan to a private plan it is very hard to get back on the public plan. This prevents people from gaming the system – holding cheaper private insurance while they’re young, healthy and earning money, then trying to switch back during their retirement, but it also can leave people out in the cold with no insurance.

In Canada, each province has a single, government-run insurance provider that charges non-actuarial premiums (premiums based on how much you make, not how likely you are to use healthcare services). This guarantees universal coverage, but also results in some services (especially those without empirical backing, or where the cost-benefit is too low) remaining uncovered. Canada also prohibits mixing of public and private funds, making private healthcare much more expensive.

Canadians aren’t spared hard choices, we just have to make different trade-offs than Americans. Here we must pick (and did pick) between “the government shouldn’t decide who lives and who dies” and “care should be universal”. This choice was no less wrenching then any of those faced by Obamacare’s drafters.

Municipalities face similar challenges around housing policy. San Francisco is trying to retain the character of the city and protect existing residents with rent control and strict zoning regulations. The Region of Waterloo, where I live, has gone the other way. Despite a much lower population and much less density, it has almost as much construction as San Francisco (16 cranes for Waterloo vs. 22 for SF).

This comes at a cost. Waterloo mandated that houses converted into rental properties cannot hold more than three unrelated tenants per unit, thereby producing guaranteed renters for all the new construction (and alleviating concerns about students living in squalid conditions). The region hopes that affordability will come through densification, but this cuts down on the options student renters have (and can make it more expensive for them to rent).

Toronto is going all out building (it has about as many cranes on its skyline as Seattle, Los Angeles, New York, San Francisco, Boston, Chicago, and Phoenix combined), at the cost of displacing residents in rooming houses. There’s the hope that eventually supply will bring down Toronto’s soaring house costs, but it might be that more formal monthly arrangements are out of the reach of current rooming house residents (especially given that rent control rules have resulted in a 35-year drought on new purpose-built rental units).

In all of these cases, it’s possible to carve out a sacred principle and defend it. But you’re going to run into two problems with your advocacy. First, there’s going to be resistance from the middle of society, who have probably settled on the current trade-off because it’s the least offensive to them. Second, you’re going to find people on the other underserved extreme, convinced all the problems they have with the trade-off can be alleviated by the exact opposite of what you’re advocating.

Obamacare looked like it would be impossible to defend without Democrats controlling at least one lever of government. Republicans voted more than 50 times to repeal Obamacare. Now that they control everything, there is serious doubt that they’ll be able to change it at all. Republicans got drunk on the complaints of people on the long tails, the people worst served by Obamacare. They didn’t realize it really was the best compromise that could be obtained under the circumstances, or just how unpopular any attempt to change that compromise would be.

(To be entirely fair to Republicans, it seems like many Americans, including many of those who opposed Obamacare up until Obama left office, also just realized it was the best possible compromise.)

This is going to be another one of those posts where I don’t have a clear prescription for fixing anything (except perhaps axing rent control aka “the best way to destroy a city’s rental stock short of bombing it”). I don’t actually want to convince people – especially people left out of major compromises – not to advocate for something different. It’s only through broad input that we get workable compromises at all. Pluralistic society is built on many legitimate competing interests. People are motivated by different terminal values and different moral foundations.

Somehow, despite it all, we manage to mostly not kill each other. Maybe my prescription is simply that we should keep trying to find workable compromises and keep trying not to kill each other. Perhaps we could stand to put more effort into understanding why people ask for what they do. And we could try and be kind to each other. I feel comfortable recommending that.

Epistemic Status: Model

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