Conservatives, Tea Partisans Still Really, Really Angry about ObamaCare
Or at least, that’s what The Daily Caller says a Republican pollster says:
A year may have passed since Obamacare passed, but conservatives are still angry as hell about it.
Expect the legislation to play a large role in the 2012 elections, according to John McLaughlin, who recently conducted a series of focus groups for the research group Resurgent Republic. The group is run by some of the country’s best-known Republicans.
“My guess it it’s going to be a big election issue next year,” McLaughlin said in an interview…
When it comes to President Obama’s health care law among these voters, the perception of these voters has hardly changed: the intensity remains strong and they still want it repealed, McLaughlin said.
ObamaCare‘s overall numbers don’t look any better, either.
Dartmouth Withstands the NYT, but the Left Cannot Withstand Dartmouth
Research by scholars at Dartmouth Medical School suggests that Americans waste gobs of money on medical care. Last week, The New York Times ran a fairly lame critique of the Dartmouth research, by Reed Abelson and Gardiner Harris. Kate Steadman of Kaiser Health News provides a good synopsis of expert reaction to the story and writes, “Conservative and libertarian health policy bloggers were largely silent, ignoring the debate.” Although this libertarian wasn’t exactly ignoring the debate, the categorization is largely fair. More about that in a moment.
Abelson and Harris’s portrayal of the Dartmouth research is completely at odds with my understanding of that research.
Source: www.dartmouthatlas.org
Decades ago, Dartmouth researchers stumbled across what may be the best method of detecting wasteful spending in an economic sector as complicated as medicine. They noticed that patients in some areas consume a lot more medical care than patients in other areas — more office visits (to specialists in particular), more diagnostic tests, more procedures, more hospitalizations, et cetera. And they began to question whether the patients who consume more care actually benefit from that additional care. They have therefore spent the past few decades measuring both geographic variation in medical consumption, as well as any benefits for which they can find data. Do patients in high-spending areas start out sicker than patients in low-spending areas? Do they end up healthier? Are they more satisfied with their care? My sense is that the Dartmouth researchers are scientists trying to capture the empirical reality of America’s health care sector. They have been doing this for a long time, they are very good at it, and they consistently find that a lot of the medical care that Medicare patients consume appears to provide no value.
That finding has drawn intense criticism, not least from health care providers in high-spending areas, whose resource use it calls into question. Dartmouth researchers have tried to address those criticisms by approaching the issue from whatever angles the data will allow. Read the rest of this post »
Constitution Offers No Haven to ObamaCare’s Individual Mandate
With multiple lawsuits challenging the constitutionality of ObamaCare’s “individual mandate,” the law’s backers have proffered two principal arguments in its defense. First, they claim that Congress has the power to require U.S. residents to purchase health insurance under the Constitution’s grant of power “to regulate Commerce…among the several States.” Second, they claim the measure is authorized by the taxing power.
Regarding the commerce power, Cato senior fellow Randy Barnett explains in yesterday’s Wall Street Journal:
[T]he Court has never upheld a requirement that individuals who are doing nothing must engage in economic activity by entering into a contractual relationship with a private company. Such a claim of power is literally unprecedented.
Barnett also explains that the text of the law precludes ObamaCare’s defenders from claiming that the individual mandate is authorized by the taxing power. The individual mandate defines a minimum level of coverage and then imposes a penalty on people who do not purchase such coverage. Barnett notes that the law invokes the commerce power (not the taxing power) to justify the mandate, and refers to the penalty for non-compliance as a “penalty” (not a tax):
In short, the “penalty” is explicitly justified as a penalty to enforce a regulation of economic activity and not as a tax. There is no authority for the Court to recharacterize a regulation as a tax when doing so is contrary to the express and actual regulatory purpose of Congress.
At National Review Online, Cato chairman Bob Levy explains, “even if the penalty for noncompliance is deemed to be a tax rather than a fine, it does not meet the constitutional requirements for income, excise, or direct taxes,” and would be an unconstitutional tax.
ObamaCare Is RomneyCare 2.0
Former Massachusetts governor and possible 2012 presidential contender Mitt Romney has spent a lot of time campaigning against the recent health care overhaul.
One problem: It looks a lot like the law he signed in 2006 while he was governor of Massachusetts.
“In every important respect the Obama plan and the Romney plan are identical,” says Michael Cannon, Cato director of health policy studies.
In a new video, Cato’s David Boaz and Michael Cannon explain how alike the two plans really are. Watch:
ObamaCare: “Everything That’s Wrong with the European-style Democratic Socialist State”
From Jeffrey H. Anderson, writing at National Review Online’s Critical Condition blog:
With Obamacare, President Obama has given a concrete example of everything that’s wrong with the European-style Democratic Socialist state, all wrapped up in one (massive) package. The notions are no longer abstract or theoretical. They’re here for all to see: less liberty, more taxes, more public indebtedness, more intergenerational theft, taxpayer funding for abortion, government rationing of health care, consolidation and centralization of power in Washington, and politicization of the properly private relationship between patient and doctor. The American people don’t want any of this, which is why 54 percent of Americans, including 59 percent of independents, are for repeal. Let’s give it to them.
Repeal the bill.
Could Obamacare Survive a Fiscal Crisis?
Over at Think Markets, NYU’s Mario Rizzo asks how Obamacare might be repealed. He focuses on the fiscal brawl that will occur when the Medicare cuts must be implemented. Let’s take a look at another fiscal scenario.
The Greek debt crisis is just the leading edge of a global debt crisis in developed countries. It is not Greece that matters to the rest of the European Union, but the precarious position of other highly indebted EU members: Portugal, Italy, Ireland, and Spain. Fiscally sound Germany could bail out Greece, but not all the others. A Greek default (likely if not inevitable) will fracture the EU and the contagion surely would spread to the United States.
The result will be what I call a Leninist moment. Lenin famously observed that a situation must often get worse before it can get better. He had a different idea of what better would be than do libertarians, but his insight is nonetheless correct.
The resulting fiscal crisis in the United States would finally force a serious debate over fiscal discipline. Not even eliminating all defense expenditures would close the budget gap. Could Obamacare survive the crisis?
CBO: ObamaCare Would Increase Deficits by $59 Billion
Of course, it depends on what the meaning of “the Obama health plan” is.
If the Obama plan is understood not to include the $208 billion Medicare “doc fix” that the House removed from its bill to pass separately, and if the Obama plan would be sealed in an impenetrable vault within the National Archives, never again to be touched by God or man, then yes, the Congressional Budget Office predicts the Obama plan would reduce federal deficits by $138 billion over the next 10 years and by maybe one-half percent of GDP in the 10 years after that.
If, however, the doc fix is actually part of the Obama plan, and that law would be subject to normal political forces plus the new political dynamics the law would create, then the CBO predicts the Obama plan would increase federal deficits by $59 billion over the next 10 years and maybe one-quarter percent of GDP in the subsequent decade.
So really, the Obama plan’s impact on the deficit comes down to which one of those scenarios best describes the Obama plan, and which one is a partisan fantasy.
WWJC?
Or, whom would Jesus coerce? That’s the question that comes to mind when I read the Center for American Progress’ latest attempt to argue that, if Jesus were a member of Congress, He would vote for President Obama’s individual mandate.
I was raised Catholic, and I don’t remember Jesus teaching that we should put people in jail for not buying health insurance. As I recall, He let the priest and the Levite go their merry ways.
OK, technically all the CAP report claims is that the Obama plan is consistent with Catholic social teaching.
The authors invoke all the right Catholic doctrines: “human dignity, solidarity, special status of the poor … concern for the common good … stewardship.” Except they omit the Catholic doctrine of subsidiarity, which teaches that problems should be addressed at the most local level possible.
They left out what Pope John Paul II wrote about the welfare state in a 1991 encyclical:
By intervening directly and depriving society of its responsibility, the Social Assistance State leads to a loss of human energies and an inordinate increase of public agencies which are dominated more by bureaucratic ways of thinking than by concern for serving their clients and which are accompanied by an enormous increase in spending.
They sidestep the small matter of whether the legislation would actually force taxpayers to finance abortions, which Catholic doctrine teaches is the taking of innocent human life.
They note that “the Catholic Health Association is the largest provider of nongovernmental health care in the United States,” and the CHA has essentially endorsed the Obama plan. They do not mention the material fact that the CHA therefore depends on the government for much of its revenue, and is susceptible to retribution if it doesn’t play ball.
But I keep coming back to the absurdity of suggesting that using government coercion to achieve social change is the Christian thing to do. The authors do not channel Christ so much as Richard III:
And thus I clothe my naked villany
With old odd ends stolen forth of holy writ,
And seem a saint when most I play the devil.
Or to put it differently, they cast their lots with Caesar, not Christ.
ObamaCare Sparks Democratic Revolt
In today’s Washington Post, Democratic pollsters Pat Caddell and Doug Schoen warn that ObamaCare will be a disaster for Democrats:
Nothing has been more disconcerting than to watch Democratic politicians and their media supporters deceive themselves into believing that the public favors the Democrats’ current health-care plan…
[A] solid majority of Americans opposes the massive health-reform plan. Four-fifths of those who oppose the plan strongly oppose it…while only half of those who support the plan do so strongly. Many more Americans believe the legislation will worsen their health care, cost them more personally and add significantly to the national deficit. Never in our experience as pollsters can we recall such self-deluding misconstruction of survey data…
By 51 percent to 39 percent, respondents feared the decisions of federal government more. This is astounding given the generally negative perception of insurance companies…
Health care is no longer a debate about the merits of specific initiatives…[but] about the government and a political majority that will neither hear nor heed the will of the people.
This oped reminds me of a Bruce Reed article on the differences between hacks and wonks:
Krugman Don’t Know Health Insurance
When I debated Nobel Prize-winning economist Paul Krugman on health care reform, I asked him if he was familiar with the work of University of Pennsylvania economist Mark Pauly. Pauly is a leader in the economics of health insurance. He and his coauthors have shown that health insurance markets are way ahead of politicians — and way ahead of economists — in solving the problems that bedevil health insurance markets. I already knew the answer: only someone completely oblivious of Pauly’s work could have debated as Krugman did. (As Krugman himself demonstrated in that debate, you never want to ask a question to which you don’t already know the answer.)
Krugman’s column in today’s New York Times tells me that he still has not read Pauly.
Krugman addresses the 39-percent premium increases that insurer Wellpoint planned to impose on its California customers:
WellPoint claims … that it has been forced to raise premiums because of “challenging economic times”: cash-strapped Californians have been dropping their policies or shifting into less-comprehensive plans. Those retaining coverage tend to be people with high current medical expenses. And the result, says the company, is a drastically worsening risk pool: in effect, a death spiral.
Krugman then argues that if Wellpoint’s explanation is accurate, then that demonstrates that free-market reforms would cause private insurance markets to collapse, and demonstrates further the need for government to impose price controls on health insurance and to force healthy people to purchase it.
Yet there are at least two major problems with Wellpoint’s story.
- Healthy people dropping coverage would not lead to across-the-board premium increases in California, because California allows markets to set premiums. Only when the government imposes the kind of price controls that Krugman wants does an “adverse selection death spiral” follow.
- Krugman may be thinking, “Even with market prices, once the healthy people drop out, insurers must raise premiums to cover the future costs of the sick people who remain.” Yet Pauly and his colleagues show that insurers collect the money they need to cover those costs in advance by “front-loading” premiums.
Obama Admits CBO Cost Estimates of ObamaCare Are Incomplete
Yesterday — day #224 of the ObamaCare Cost-Estimate Watch — President Obama told House Republicans:
You can’t structure a bill where suddenly 30 million people have coverage and it costs nothing.
And just like that, the president admitted that the official Congressional Budget Office estimates of his health care plan do not reflect its full costs.
Both the House and Senate versions of ObamaCare would cover millions of uninsured Americans by requiring them to purchase private health insurance. As President Obama notes, even if you force people to spend their own money on health insurance, it still costs something to cover them. And if the government partly subsidizes those premiums, the remaining mandatory premium is still part of the cost of covering them.
Yet Democrats have systematically blocked the CBO from including those costs in its official cost projections. The Senate bill’s estimated price tag of $940 billion, for example, includes only the costs that bill would impose on the federal government. By my count, that’s only 40 percent of total costs. By Mr. Obama’s admission, that’s not the full cost of the bill.
Now that the President of the United States has acknowledged that the CBO’s cost estimates are incomplete, could we maybe get a complete cost estimate? Maybe just for the Senate bill?
Reforming Previous Reforms, ad Infinitum
In the forthcoming issue of Cato Policy Report, Jeffrey Friedman describes the cumulative effects of regulations that led to the 2008 financial collapse:
So deposit insurance begat bank-capital regulations. Initially these were blunderbuss rules that required banks to spend the same levels of capital on all their investments and loans, regardless of risk. In 1988 the Basel accords took a more discriminating approach, distinguishing among different categories of asset according to their riskiness — riskiness as perceived by the regulators. The American regulators decided in 2001 that mortgage-backed bonds were among the least risky assets, so they required much lower levels of capital for these securities than for every alternative investment but Treasurys. And in 2006, Basel II applied that erroneous judgment to the capital regulations governing most of the rest of the world’s banks. The whole sequence leading to the financial crisis began, in 1933, with deposit insurance…
Deposit insurance, hence capital minima, hence the Basel rules, might all have been a mistake founded on the New Deal legislators’ and regulators’ ignorance of the fact that panics like the ones that had just gripped America were the unintended effects of previous regulations.
Friedman is talking about financial and housing regulation. But I was reminded of them when I heard President Obama tell congressional Democrats, “Today we are on the doorstep of accomplishing something that Washington has been talking about since Teddy Roosevelt was President, and that is reforming health care and health insurance here in America.” And his formal speech to Congress in September: “I am not the first President to take up this cause, but I am determined to be the last.”
But of course we’ve been “reforming” health care ever since Teddy Roosevelt, and those reforms have brought us to our present difficulties. The Flexner Report 100 years ago reduced the supply of doctors and drove up the price. Wage and price controls during another Roosevelt era led to the system of employer-provided insurance, again driving up costs. Medicare and Medicaid poured more third-party payments into the system and added layers of government bureaucracy. HMOs and other cost-containment measures were a response to a problem created by the absence of normal consumer pressure. Then we got HIPAA, Kennedy-Kassebaum, the Mental Health Parity Act, state mandated-coverage laws, and the Medicare Prescription Drug Benefit.
And here we are today, with a health care system that everyone agrees needs reform. Maybe it’s time to recognize that we’re just piling new regulations on top of old regulations, like some compulsory Rube Goldberg device, and to try instead free markets, in which consumers pay for what they want from providers, insurance companies, managed care organizations, and other entities that compete for their business by seeking to provide better care at lower prices. Otherwise, we can be sure that Barack Obama won’t be the last president to stand before Congress and declare that our health insurance system needs reform. Indeed, we can bet that if he signs the current bill, he himself will be back before Congress in a year or two asking for reforms to reform the reforms that were intended to reform the previous reforms.
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