Tag: Cost-Benefit Analysis

Yes, Florida Voters Oppose ObamaCare’s Medicaid Expansion

Bloomberg’s Josh Barro criticizes the James Madison Institute’s poll showing that 65 percent of Florida voters oppose implementing ObamaCare’s Medicaid expansion. Barro is mostly wrong. But even when he’s right, he’s still wrong. Disclosure: I helped JMI formulate their poll questions.

Barro complains that JMI conducted a “push poll.” His first complaint is:

It starts by priming respondents with questions about the national debt and the size of Florida’s existing Medicaid budget.

Then it gives an inaccurate description of the terms of the expansion. Poll respondents were told that Medicaid currently covers people earning up to 100 percent of the federal poverty line. That’s not true: In Florida, the limit for adults is 56 percent of FPL, and you must have dependent children to qualify.

Though Barro slightly mischaracterizes the poll question, he is basically correct, and the inaccuracy is my fault.

The folks who originally drafted JMI’s poll questions aren’t health care wonks, so they ran their questions by me. This question was originally worded the way Barro claims the final question was: “Medicaid coverage is currently available for those with incomes up to 100% of the poverty line.” I hurriedly emailed the JMI folks, “Florida does not offer Medicaid coverage to everyone below 100 percent of poverty. See page 2 and table 3 of this report. You might replace ‘currently’ with ‘generally.’” So that’s what JMI did. In retrospect, Barro is right. “Generally” gives the impression that Medicaid is available to more Floridians below the poverty line than is actually the case, and I should have offered a better edit. Mea culpa.

His next complaint is not accurate:

Respondents also heard that after three years, the state would be on the hook for “more than 10 percent” of the cost of newly eligible adults. That’s not true, either: The state’s share would be exactly 10 percent.

Under current law, for the first three years the feds pay for 100 percent of the cost of claims for newly eligible adults. They do not pay 100 percent of the administrative costs of covering those adults. States have to pick up much of that cost (as well as other costs related to other parts of the expansion). So the question is accurate and Barro is wrong. He’s not a health care wonk, though, so he can be forgiven for this one.

But Barro’s third complaint is the real doozy:

ObamaCare’s Priceless Warm Glow

Ed Kilgore says ObamaCare opponents don’t care about cost-benefit analyses:

many of them just can’t bring themselves to even notice that…Obamacare with its Medicaid expansion, health care exchanges, and regulatory mandates [does] actually provide health coverage to people in exchange for the money and the “liberty” surrendered.

Speaking of, what is the exchange rate between liberty and “liberty”?

But about those benefits. What benefits do broad-based expansions of health insurance, like ObamaCare, actually provide? Aside from giving Kilgore a warm glow, that is.

It turns out there has been only one—one!—scientifically rigorous study of that question. The Oregon Health Insurance Experiment found Medicaid coverage confers modest improvements in self-reported health and financial security. The first batch of that study’s results appeared more than a year after Congress enacted ObamaCare. And there remains to this day absolutely zero evidence that Medicaid or other broad-based expansions of health insurance buy us the most health and financial security per dollar spent.

Then again, the Oregon Health Insurance Experiment did not attempt to measure the value of the warm glow that Kilgore and others derive from Medicaid and ObamaCare, one that appears to be worth trillions of dollars of other people’s money.

OMB Watch Opposes Regulation With Demonstrable Benefits

There’s only a little bit of unfairness in the title I’ve given this post, the suggestion that OMB Watch President and CEO Katherine McFate opposes regulation that has benefits. But she does lament the requirement that the benefits of regulation be shown, which is a sibling of not prioritizing benefits at all.

In a post entitled: “Cost-Benefit Analysis: The Stunning Triumph of a Flawed Tool,” she writes: “It is simply not appropriate to apply cost-benefit analysis to many aspects of policymaking, and the results from such analyses should not be the final determinant of the value of many proposed standards or safeguards.”

It’s not a new argument. And I disagree with it. All aspects of policymaking should be subjected to cost-benefit analysis. All policies should provide us more in benefits than they burden us with costs. Just think how much we’d save on military adventurism…

Here’s the heart of McFate’s complaint:

Many regulatory experts and members of the public interest community believe cost-benefit analysis exaggerates the costs of new rules and underestimates their social benefits. Cost-benefit analyses are heavily dependent on the assumptions built into the quantitative models used and the data on which the models are applied. The data is provided by regulated businesses. If these businesses are resisting the need to change their production processes or business practices to comply with a new standards or regulation, they will tend to overestimate the compliance costs of the rule.

Nothing here undercuts cost-benefit analysis per se. McFate’s complaint is that “the other side” is skewing cost-benefit analysis in its favor.

McFate is right that the benefits of safety and health are harder to quantify than the cost of regulations to deliver them. And she’s right that business ingenuity goes into cutting compliance costs after rules have issued, making initial cost-estimates seem high. But those are reasons for groups like OMB Watch to get better at cost-benefit analysis, not reasons to quit the game.

The federal government has hoovered up control over huge swaths of Americans’ economic and social lives, subjecting manifold organs of society to central control contrary to my preference. If the government’s decisionmaking is not to be guided by cost-benefit analysis, then what? McFate doesn’t say. But she does say:

Americans have a right to safe drinking water, clean air, safe workplaces, safe food, safe drugs, and safe toys. They expect their government to ensure these basic protections. End of story. The value of maintaining and improving the health and safety of the American people? Priceless.

In this romantic, choking swirl of positive rights, we pick up McFate’s view: the United States government should spend any amount of society’s resources on her goals, nevermind whether it makes society better off as a whole. I’ll take cost-benefit analysis.

OMB Watch should focus on making cost-benefit analysis better, rather than giving up on regulation with demonstrable benefits.

How Much Homeland Security Is Enough? Monday Book Forum

At noon Monday, Professors John Mueller and Mark Stewart will be here to discuss their new book: Terror Security and Money: Balancing the Risks, Benefits and Costs of Homeland Security. Register here.

The question in this post’s title is the book’s. It quantifies Mueller’s skepticism about the utility of homeland security spending with cost-benefit analysis, which is Stewart’s specialty. They use this analysis, which is employed by various federal agencies as part of the regulatory review process, to show that little of what the Department of Homeland Security does is a good investment. That is, the bulk of its activities cost more—measured in lives or dollars— than they save. In the conclusion, where you find most of the book’s political science, Mueller and Stewart discuss why DHS avoids this sort of analysis—neither it nor its political advocates have much reason to advertise its wastefulness—and why that should change.

Alan Cohn, Deputy Assistant Secretary for Policy at DHS, has boldly agreed to join the proceeding. DHS rules prohibit him from commenting directly on the book, but he will presumably defend his department and discuss how it considers policies’ cost and benefits, or what it calls risk management.

That all sounds very wonky, I know. Here is why the book and forum should interest those not particularly concerned with homeland security or risk analysis: the book calls a bluff. One of the great myths about U.S. national security is that it aims to maximize safety. Almost everyone speaks about security as if this were so.

The truth is instead that every security policy, indeed every government policy, is a choice among risks. Most policies aim to mitigate risk in some way and by expending resources expose us to other risks. Our policy preferences and ideologies are largely beliefs about which risks to combat socially and which to leave to individuals, or least how much attention we should pay to competing risks. Our society, it turns out, is willing to pay far more to save lives from terrorism than most other dangers. That is, we value lives lost from it far more highly than those lost in other ways. We trade small gains in protection from terrorists for substantial losses in our ability to combat other troubles.

By asking what U.S. homeland security would look like it if truly aimed to maximize safety against all dangers, Mueller and Stewart’s book makes plain that we have chosen to do otherwise. People that disagree about the merit of that choice should agree at least that it is one we should make openly. Democracies make better choices when they perceive them.

Take Your Stinking Paws Off My Benjamins You Damn Dirty Statist

Okay, perhaps the title of this post is not quite as memorable as Charlton Heston’s famous line from Planet of the Apes, but it certainly captures my sentiments after reading an article in Slate that calls for the elimination of the $100 bill. The author, Timothy Noah, says that large bills are only for “criminals and sociopaths.” Here’s the crux of his argument.

…why does the U.S. continue to print C-notes…? Technological change has reduced much further the plausible need of any law-abiding American to carry a C-note in his wallet or to stash a pile of C-notes in his mattress.

Noah’s argument is unconvincing for several reasons. First, he is underestimating the degree to which “law-abiding” Americans use “Benjamins.”  And with higher inflation almost certainly around the corner, one can safely expect that $100 bills will become even more common in the future. Second, his entire argument rests on the statist assumption that government should restrict honest people because this will somehow make life more difficult for criminals. Yet he debunks his own anti-money laundering argument by noting that the government already has stopped printing larger bills, such as the $500 note. Has that stopped the drug trade? Hello? Anyone? Bueller?

Like much of what government does, the campaign against money laundering is a costly exercise with very few tangible benefits. This video examines the cost-benefit issues.

I actually think the moral arguments against anti-money laundering laws are even more powerful. As Americans, we should have a presumption of innocence in our daily lives. What business is it of government whether we want to carry $20 bills or $100 bills? And think about the implications of these laws. What if the government said we need to ban cars, or put government-monitored homing devices in all vehicles, because bank robbers occasionally use automobiles as getaway vehicles? In this case, there is a theoretical benefit to the policy, just like there is a somewhat plausible case for anti-money laundering laws, but presumably we would reject such a policy as too intrusive.

Anti-money laundering laws are a classic case of bad policy leading to more bad policy. The government passes drug laws that create huge profits for criminals. But rather than getting rid of victimless crimes, the government imposes policies that make life more difficult and costly for everyone else.