Archives: 09/2010

ObamaCare & Health Insurance Premiums: Out of the Frying Pan, into the Fire

During the (initial) congressional debate over ObamaCare, President Obama vilified Anthem Blue Cross of California for a 39 percent rate increase.  On Wednesday, the Hartford Courant reported that ObamaCare itself may increase premiums by similar amounts:

Health insurers are asking for immediate rate hikes of more than 20 percent in Connecticut for some plans, citing rising medical costs and federal health reform laws as reasons…

In what might appear to be an oddity, companies are citing a huge range of effects that the health care reform mandates will have on plan prices — from near zero to well over 20 percent. The reason is that among all the plans, some already deliver the provisions required by health reform, while others do not…

Anthem Blue Cross and Blue Shield in Connecticut, by far the largest insurer of Connecticut residents, said in a letter that it expects the federal health reform law to increase rates by as much as 22.9 percent for just a single provision — removing annual spending caps. The mandate to provide benefits to children regardless of pre-existing conditions will raise premiums by 4.8 percent, Anthem said in the letter. Mandated preventive care with no deductibles would raise rates by as much as 8.5 percent, Anthem said.

It was unclear how those separate factors would add up for Anthem’s plans, but those potential increases were all on top of rising medical costs.

If those increases are cumulative, ObamaCare could increase premiums for some Connecticut residents by more than 36 percent.

Compare that to what President Obama said in his weekly radio address on February 20:

The other week, men and women across California opened up their mailboxes to find a letter from Anthem Blue Cross. The news inside was jaw-dropping. Anthem was alerting almost a million of its customers that it would be raising premiums by an average of 25 percent, with about a quarter of folks likely to see their rates go up by anywhere from 35 to 39 percent

And as bad as things are today, they’ll only get worse if we fail to act… We’ll see exploding premiums and out-of-pocket costs burn through more and more family budgets.

It sure seems like President Obama promised that ObamaCare would make things better.  Instead, it pushed us out of the frying pan and into the fire.

HHS Secretary Katheleen Sebelius said that Anthem Blue Cross of California’s 39 percent rate increase “just doesn’t make a lot of sense to people across America.”  She said those “extraordinary” increases threaten “to make health care unaffordable for hundreds of thousands of Californians, many of whom are already struggling to make ends meet in a difficult economy.”  Will she say the same about ObamaCare’s premium increases?  Or will she threaten to put Anthem Blue Cross and Blue Shield of Connecticut out of business for its insolence?

Avoiding the ‘U’ Word

I grow increasingly amused at how some people carefully avoid saying that ObamaCare is unpopular.

When Pollster.com aggregates all the various polls on ObamaCare’s popularity, it reveals that a plurality or majority of the public has consistently opposed the law since before the angry town-hall meetings of August 2009:

It’s no surprise when HHS Secretary Kathleen Sebelius avoids the U-word by saying stuff like, “We have a lot of reeducation to do.”  (To be clear, she’s talking about reeducating you, not herself.)

But it’s odd when a Washington Post news item describes the public as “profoundly ambivalent” toward the law. (According to Merriam-Webster, ambivalence means holding “simultaneous and contradictory attitudes or feelings,” “continual fluctuation,” or “uncertainty as to which approach to follow.”)  Or when Kaiser Family Foundation president and CEO Drew Altman tells NPR: “The public is split, has been split, and continues to be split.”

I guess those descriptions are true (though “continual fluctuation” and “uncertainty” seem like a stretch).  But they’re not very informative.  “Ambivalent” doesn’t tell you if one side dominates.  “Split” could accurately describe anything shy of unanimity.  “Opposed” or “unpopular” or “consensus” would convey so much more information. Why convey less?

Michelle Rhee, Ben Chavis and I on ‘Stossel’ Tonight

Why was the recent $10 billion public school bailout bad for kids as well as taxpayers? How much does Ben Chavis’ #1 ranked middle school in California spend per pupil? Does Michelle Rhee expect to still be DC schools superintendent after Mayor Fenty leaves office? Why do I use the word “unicorn” in describing public school budgets? Tune in tonight to find out: “Stossel,” Fox Business News, 9:00pm Eastern/6:00pm Pacific.

Shifting the Blame for America’s Health Care Woes

I must be losing my touch. I’ve let nearly two months pass without responding to Ezra Klein’s defense of RomneyCare, ObamaCare, and other centrally planned health care systems.  (For those who want to get up to speed: his original post, my reply, and his response.)  So here goes.

Klein notes that he and I had each used flawed measures of RomneyCare’s impact on health insurance premiums in Massachusetts.  Fair enough.  But Klein ignores the study I cited by John Cogan, Glenn Hubbard, and Dan Kessler, which estimates that RomneyCare increased premiums in Massachusetts by 6 percent.  The CHK study has limitations, but it is the best estimate available.  I hope Klein addresses it.

Klein’s fallback position is that even if RomneyCare increases premiums, that’s not an indictment of the law because cost-control was not one of its goals.  Never mind that Mitt Romney boasted, “the costs of health care will be reduced.”  Klein knows political rhetoric when he sees it.  Yet he oddly sees no parallels between the phony-baloney promises of cost-control used to sell RomneyCare and the phony-baloney promises of cost-control used to sell ObamaCare – despite ample assistance from people like Medicare’s chief actuary and Alain Enthoven (“the American people are being deceived”).

Then Klein throws down his trump card:

[E]ven a cursory read of the evidence would show that whatever the drawbacks of central planning, it covers people at an extremely low cost. Romney Care’s cost problem is a result of pasting a coverage-oriented quick fix atop our insane health-care system. Compare its costs to the British system, the French system, the German system, or any other system, and whatever your conclusions, you won’t walk away unimpressed by the ability of centralized systems to cover whole populations for much less money than we spend.

Oy, where to begin?  First, Klein violates Cannon’s First Rule of Economic Literacy: he writes that centrally planned systems cost less, when what he means is that they spend less.

Second, the phrase “whatever the drawbacks of central planning” is some serious hand-waving.  Those “drawbacks” include (among other things): the Medicare program’s suppression of comparative-effectiveness research, error-reduction efforts, care coordination, and other delivery innovations; Canada’s human-rights violating Medicare system; and the suppression of untold innovations in health insurance and medical treatment by government price controls.  Other than a few drawbacks, Mrs. Lincoln…

Third, our “insane health-care system,” as I blogged previously, “is the product of the old raft of government price & exchange controls, mandates, and subsidies.”  Prior to ObamaCare, government already controlled half of all U.S. health care spending directly, granted control over another quarter to employers, and regulated health care more heavily than perhaps any other sector of the economy.  Klein and his fellow central planners can’t deny paternity.  Our “insane health-care system” is the product of central planning.

Finally, only a cursory read of the evidence could lead to the conclusion that central planning contains health care spending.  Klein posts the following charts and concludes that since all those (other) centrally planned systems spend less on health care than the United States, central planning must result in lower health care spending.

Photo credit: By Robert Giroux/Getty Images

But if that were true, then one would expect per-capita spending on elderly Americans – who have universal coverage through the centrally planned Medicare program – would not be far out of line when compared to how much other nations spend per elderly resident.  Yet the United States is just as far out of here as overall.  According to the OECD, the United States spends about twice as much per elderly person as Canada, and more than twice as much as Australia spends.  (Alas, I’m not cherry-picking; these are the only four nations for which the OECD provides recent data.)

Source: OECD, author’s calculations

(One could argue that the reason for this is that Medicare exists alongside the world’s largest (ostensibly) private health care sector, whose evils spill over into Medicare.  If that were the case, then moving all Americans into Medicare should reduce U.S. health care spending, bringing it back into line with other nations.  But consider that Klein and The New Republic’s Jonathan Chait both acknowledge that Congress had to throw $2 at the health care industry for every $1 that ObamaCare cut from future Medicare spending. How exactly could Congress move 250 million Americans into Medicare (which presumably would reduce overall spending), or reduce Medicare spending later, given those constraints?  How, exactly, would an independent rationing board survive the political dynamics that produce such outcomes? Prediction: it won’t.  The narrative that central planning contains health care spending just doesn’t hold water.)

Klein, The New Republic’s Jonathan Cohn, and others have taken a big step by acknowledging that RomneyCare is struggling.  When they shift the blame to “the American health care system,” however, they obscure what’s really happening.  As I closed my previous post: “RomneyCare and its progeny ObamaCare are attempts by the Left’s central planners to clean up their own mess.  If Klein and Cohn want to defend those laws, pointing to the damage already caused by their economic policies won’t do the trick.  They need to explain why government price & exchange controls, mandates, and subsidies will produce something other than what they have always produced.”

Striking Findings from the New Chicago Council Public Opinion Survey

I was privileged last night to get an advance look at the Chicago Council on Global Affairs’ new study on public opinion.  I was struck by several things.

First, the report reflects a strong desire to get our own house in order.  Asked the question whether it “is more important at this time for the United States to fix problems at home or address challenges to the United States from abroad,” a stunning 91 percent selected the former, with only 9 percent pointing to the latter.  (In 2008 the numbers were 82-17.)

That said, there is not as much appetite for cutting the defense budget as I would like to see:

When asked whether defense spending should be expanded, kept about the same, or cut back, 43 percent of Americans prefer to keep spending about the same as it is now, a steady position since 2004, with 30 percent saying expand and 27 percent saying cut back. At the same time, Americans do recognize the need for moderation if federal budget cuts are necessary to reduce the deficit. When asked whether the defense budget should be cut along with other programs in an effort to address the federal budget deficit, a majority (58%) favors at least some cuts—less than other programs (29%), about the same as other programs (20%), and greater than other programs (9%). A substantial number (41%), however, say defense should not be cut at all. Along with the 29% who say it should be cut less than other programs, there is a considerable majority that clearly sees defense spending as a high priority.

Second, the report does a good job of highlighting the fact that although a historically high number of Americans (49%) agree with the idea that America should “mind its own business internationally and let other countries get along the best they can on their own,” this is not, as it is frequently advertised, “isolationism.”  One needs to define what “our own business” is before one can characterize such a belief.

But perhaps the most striking findings, to my mind, pertained to the U.S.-Israel relationship.  On a general question regarding whether various other countries are “very important” to the United States, Israel fell 7 points from the 2008 figure (from 40 percent to 33 percent), but every country except China suffered a decline, except Iraq, South Korea, and Turkey, which stayed the same.  But the report asked a number of specific questions pertaining to Israel–and U.S. policy toward Iran–that produced answers that were surprising to me:

• On the issue of Iran acquiring nuclear weapons, Americans are at present reluctant to resort to a military strike on Iran’s nuclear facilities, preferring economic sanctions and diplomacy.  [Only 18 percent support a strike.]

• Very strong majorities do not think it is likely that a military strike would cause Iran to give up trying to have a nuclear program. They also think a strike would likely result in retaliatory attacks against U.S. targets in neighboring states as well as in the United States itself.  [28 percent say it is “not at all likely” and 48 percent say “not very likely” that striking would lead Iran to give up trying to have a nuclear program.]

• If all efforts fail to stop Iran, Americans are about evenly divided on whether to conduct a military strike. [47 percent would favor a strike, 49 percent would oppose.  This surprised me a lot.]

• If Iran were to allow UN inspectors permanent and full access throughout Iran to make sure it is not developing nuclear weapons, a slight majority of Americans believe that Iran should be allowed to produce nuclear fuel for producing electricity. [52 percent would support, 45 percent would oppose, which reflects a slight shift away from allowing Iran enrichment from the findings in 2008.]

But perhaps most striking were these findings, which I would imagine will cause heartburn for Binyamin Netanyahu:

[Americans] also appear to be very wary of being dragged into a conflict prompted by an Israeli strike on Iran’s nuclear facilities. In this survey, conducted in June 2010, a clear majority of Americans (56%) say that if Israel were to bomb Iran’s nuclear facilities, Iran were to retaliate against Israel, and the two were to go to war, the United States should not bring its military forces into the war on the side of Israel and against Iran…

[…]

Americans continue to show wariness about defending Israel from an attack by its neighbors. Despite an increase in the percentage of Americans who think military conflict between Israel and its Arab neighbors is a critical threat (from 39% in 2008 to 45% today), Americans are divided on using U.S. troops to defend Israel if it were attacked by “its neighbors” (50% opposed, 47% in favor, see Figure 52). This question was also asked with a slightly different wording in surveys from 1990 to 2004 (if Arab forces invaded Israel). In none of these surveys was there majority support for an implicitly unilateral use of U.S. troops.

Food for thought.

High-Speed Rail Battle

Wisconsin has become a battleground over the Obama administration’s plan to create a national system of high-speed rail. Of the $8 billion in HSR grants awarded to the states in the stimulus bill, $810 million of it went toward a high-speed route between Milwaukee and Madison.

Ironically, this Wisconsin “high-speed” route would only achieve speeds of 79 mph initially and 110 mph by 2016. As a Cato essay on high-speed rail points out, HSR aficionados don’t even consider 110 mph to be true high-speed. In fact, passenger trains were being run at speeds of 110 mph or more back in the 1930s. And those “high-speed” trains didn’t prevent the decline of passenger trains after World War II.

The Cato essay also notes that the 85-mile line between Milwaukee and Madison “is only a tiny portion of the eventual planned route from Chicago to Minneapolis, and no one knows who will pay the billions necessary to complete that route.” In fact, to build a national system of true high-speed rail on the 12,800 mile network envisioned by the administration, the cost could be close to $1 trillion.

Where would the money come from? State governments are hoping that it would be all from federal taxpayers. As I recently discussed, the states’ interest in grabbing new federal HSR money has dropped now that Congress is requiring a 20 percent state match:

The states already have dedicated revenue sources for federal highway aid matching requirements (also 20 percent). With state tax revenues flat due to the recession, where would the money come from to pay for high-speed rail projects? Proposing new taxes to fund high-speed rail would probably be political suicide. And most state policymakers recognize that shifting money away from more popular programs to pay for high-speed rail won’t be any more politically rewarding.

The issue is even affecting elections in states that are in line to receive federal funding for high-speed rail. Scott Walker, a Republican candidate for governor in Wisconsin, recently said he’d send back the $810 million in stimulus funds the state has received for a rail line between Madison and Milwaukee. Walker appears to understand that his state has more pressing infrastructure needs and that high-speed rail could become a fiscal black hole.

On Tuesday, Walker won the GOP primary to replace outgoing Democratic Governor Jim Doyle, who is an ardent supporter of the Milwaukee-Madison route. Walker’s Democratic opponent, Milwaukee mayor Tom Barrett, supports the route’s construction. According to Stateline.org, the outgoing Doyle administration plans to have $300 million of the money under contract by January, which Walker says he would cancel if elected.

Wisconsin Democrats have made hay out of the fact that former Republican Governor Tommy Thompson first championed the idea of a regional network of high-speed rail. Unfortunately for HSR proponents, Thompson’s past involvement with federally-subsidized rail is a reason not to build the route.

From a Cato essay on Amtrak subsidies:

Amtrak reform legislation in 1997 stipulated that its board be replaced with a “reform board” of directors. The Clinton administration nominated, and the Senate confirmed, politicians that included the then-governor of Wisconsin, Tommy Thompson, and the mayor of Meridian, Mississippi, John Robert Smith. Mayor Smith tried to create a route that would have lost millions linking Atlanta and Dallas via Meridian. Governor Thompson succeeded in creating a route from Chicago to Janesville, Wisconsin. It was eventually discontinued after Thompson’s departure from the board due to low ridership and financial losses.

As is the case with Amtrak, HSR can’t compete with more efficient modes of transportation like automobiles and airplanes without massive subsidies. At a time when the federal debt is heading toward the moon, policymakers should be looking to the private sector to take care of our transportation needs. The country simply can’t afford to sink taxpayer money into high-speed rail when it makes so little economic sense.

Another Judicial Takings Case Headed to the Court

The Montana Supreme Court overturned more than 100 years of state property law concerning navigable waters by effectively converting the title in hundreds of miles of riverbeds to the State. The majority of that court ruled that the entirety of the Missouri, Clark Fork, and Madison rivers were navigable at the time of Montana’s statehood, producing a broad holding that eradicates property rights to the rivers and riverbanks that Montanans had enjoyed for over a century.

Before this case, the hydroelectric energy company PPL Montana and thousands of other private parties exercised their property rights over these non-navigable stretches that the state never claimed.  Today, Cato joined a brief filed by the Montana Farm Bureau Federation supporting the PPL Montana’s request that the U.S. Supreme Court review the Montana high court’s ruling for possible Takings Clause violations under the Fifth Amendment.

We argue two main points.  First, that the Court should adhere to its standard for navigability rights set out in Utah v. U.S. in 1933. Unlike the approach taken by the Montana Supreme Court’s majority — that entire rivers were navigable simply because certain reaches of the river were navigable — the U.S. Supreme Court in Utah used an approach of meticulously analyzing the rivers at issue section-by-section. Second, this arbitrary ruling against rights long protected by Montana law amounts to a “judicial taking,” as explained last term Stop the Beach Renourishment v. Florida Dept. of Environmental Protection (in which Cato also filed a brief). There, a plurality of the Court held that there is no “textual justification” for limiting takings claims deriving from executive or legislative action, thereby extending it to a judicial action of the same nature (and two other members of the Court found potential relief in the Fourteenth Amendment’s Due Process Clause). Here, the Montana court did exactly that, violating due process rights that the Montana legislature could not and further violating the procedural due process rights of the thousands harmed by the decision in not affording them notice or a hearing.

The U.S. Supreme Court should thus review the case to reinforce its Utah precedent and ensure that arbitrary judicial takings of this sort cannot continue.  The name of the case is PPL Montana, LLC v. Montana.  The Court will decide later this fall whether to take it up.