Tag: Ezra Klein

ObamaCare Remains Unpopular, or Round Two of My Exchange with Maggie Mahar

Maggie Mahar responds to my response to her critique of Michael Tanner’s claim that ObamaCare is deeply unpopular.  Mahar’s alternative narrative, espoused by many on the Left, is that “the more voters learn more about the reform legislation, the more they seem to like it.”

Mahar shows that her narrative works if you begin looking for a trend at the high-water mark of opposition, if you look at a few select polls, if you look at not-so-straightforward poll questions, if you interpret simultaneous declines in both support and opposition as growing support, and if you devise a rationale for ignoring the views of those who most oppose ObamaCare.  Which is to say, her narrative doesn’t work.  ObamaCare remains deeply unpopular.

Mahar claims that support for repealing ObamaCare has been trending downward since reaching its high water mark of 63 percent on May 22, as measured by the polling firm Rasmussen Reports. This was shrewd; if you’re going to look for a downward trend, the high water mark is an excellent place to start. But it doesn’t paint an accurate picture of what’s been happening with public support for repeal. Starting on the enactment date, as I wrote before, “Rasmussen finds opposition to repeal hovering between 32-42 percent, and support for repeal hovering between 52-63 percent, with no clear trend on either side.” No clear trend, and a majority consistently supports repeal.  Check out Rasmussen’s data and see for yourself.

Next, Mahar selects a few polls that do support her narrative (e.g., Gallup, NBC/Wall Street Journal, Kaiser Family Foundation).  For example, in her first post, Mahar cites an NBC/Wall Street Journal poll from June that suggests voters would prefer a Democratic congressional candidate who didn’t want to repeal ObamaCare over a Republican who did. Aside from the results being barely statistically significant, the question she cites introduces confounding factors such as party affiliation. When that same poll asked a more straightforward question, it found that 47 percent of respondents would be enthusiastic about or comfortable with a candidate’s desire to repeal ObamaCare, compared to 40 percent who would have reservations or be uncomfortable.

Moreover, selecting just a few polls probably paints a less accurate picture than looking at something like Pollster.com, which aggregates all polls and therefore (presumably) cancels out the quirkiness of individual polls.

The above graph shows that opposition to ObamaCare surged after Obama’s inauguration and surpassed support just as the debate began in earnest in July 2009. (That rising opposition fueled the angry town halls of August 2009.) In other words, from the moment the public began to focus on ObamaCare, they didn’t like what they saw, and opponents have out-numbered its supporters for 12 months now.  (Note: the above graph only includes polls that ask the straightforward support/oppose question. It does not include Rasmussen’s polls showing broad and deep support for repeal, nor the NBC/Wall Street Journal and Kaiser Family Foundation polls Mahar cites, which show weaker support for repeal. It would be interesting to see Pollster.com aggregate the “repeal” polls.)

When Mahar turns her attention to all available polls, she argues, “if you’re looking for a trend, it’s only sensible to begin the day the bill was signed, March 23.” Why?

It was only after the final bill was passed, that people could begin to offer an opinion.

How true that is.  Also: mere voters can hardly be expected to offer an opinion about would-be presidents until after Inauguration Day.

One would think that Mahar would only insult the public’s intelligence, and dismiss the views that a plurality/majority of adults consistently expressed for 9 months, if it would help to bolster her argument.  But it doesn’t.  When we look at the trend in public opinion on ObamaCare since the signing ceremony, we see that opposition and support are declining:

If the trendline showing declining opposition to ObamaCare supports Mahar’s narrative (“the more voters learn…the more they seem to like it”), the trendline showing declining support for ObamaCare supports the opposite narrative (“the more voters learn, the less they like it”).

But recall that Mahar claims that voters are warming to ObamaCare.  When we look only at polls of adults who are registered to vote, there doesn’t appear to be any change since ObamaCare became law:

Looking just at voters also reveals that the opposition leads support by an even wider margin (9.5 percentage points).

(NB: These Pollster.com graphs will update automatically as new polling information becomes available, which may affect the trendlines.  My description of the trends and the numbers I cite are current as of July 26, 2010.  Also, readers using Internet Explorer have reported difficulty seeing the trendlines in user-generated graphs from Pollster.com.)

Finally, Mahar channels Marion Barry, who (in)famously claimed that if you don’t count murders, the crime rate in Washington, D.C., is really quite low.  She cites a poll that “suggests that opposition is largely confined to the one group that already has universal coverage–seniors,” and then invokes Ezra Klein’s rationale for dismissing their opinions:

[S]eniors, of course, aren’t opposed to government-run health care. They love their Medicare, and insofar as they have a policy concern here, it’s that the Affordable Care Act will interfere with the single-payer system they rely on.

It is nonsense to say that ObamaCare is popular if we just ignore the views of people who will suffer.  If ObamaCare weren’t taking the money for its insurance-company bailouts new government spending out of Medicare, it would have to take that money from somewhere else and those people would be angry.  (Actually, since those Medicare cuts probably won’t happen, we’ll get to see that scenario play out.)  Even if ObamaCare were popular among non-seniors, all Mahar and Klein would have established is that massive new government entitlement programs would be popular if we didn’t have to pay for them.

Investors: Fear the Process That Gave Us ObamaCare, Not Efforts to Repeal It

Ezra Klein writes:

So long as the political system is working reasonably well, we can get out from even quite a lot of debt. But the more it breaks down — the more the market sees things like the deficit commission rejected by its Republican sponsors in Congress, the more it hears threats to repeal the deficit reduction in health-care reform, the more it seems likely that Democrats will become just as unreasonably obstructionist when they become the minority — the more it has reason to worry.

I doubt that investors worry more when they hear threats to repeal ObamaCare or its Medicare cuts, which few took seriously in the first place. Given that the non-partisan Congressional Budget Office, the non-partisan chief actuary of the Medicare program, and even the International Monetary Fund have all expressed skepticism that those cuts will take effect, I expect investors have already discounted claims that ObamaCare will reduce the deficit.

More generally, the problem is not that the political system is breaking down.  That system is working pretty much the same way it always has and always will: it promotes irresponsibility.  Republicans and Democrats are merely responding to the incentives created by the system in which they operate.  (If they didn’t respond to those incentives, the political system would throw them out and replace them with people who do.)  If investors don’t already understand that, the sooner the better.

This is why responsible people want to take responsibility for our health care, etc., out of the hands of politicians.

RomneyCare Advocates: We Swear, This Time Centralized Planning Will Work

You know things aren’t going well in Massachusetts when supporters of RomneyCare write “there’s some evidence that the reforms signed into law by Mitt Romney in 2006 are struggling.”  That’s how The Washington Post’s Ezra Klein puts it in a post defending RomneyCare.  The New Republic’s Jonathan Cohn offers a similar defense.

Klein mentions only a few of the difficulties confronting Massachusetts.  Here are a few more:

  • The Commonwealth Fund reports that even though Massachusetts already had the highest health insurance premiums in the nation, premiums rose faster post-RomneyCare than anywhere else; 21-46 percent faster than the national average.
  • A recent study estimates that RomneyCare has so far increased employer-sponsored health-insurance premiums by an average of 6 percent.
  • The success that Klein sees in Massachusetts’ individual market – which accounts for just 4 percent of the private market – is merely the product of shifting costs to workers with job-based coverage.
  • Contrary to Klein’s post hoc spin that RomneyCare “was never an attempt to control costs,” Romney himself promised that “the costs of health care will be reduced.”
  • Aaron Yelowitz and I find evidence suggesting that uninsured Massachusetts residents are responding to the individual mandate not by obtaining coverage but by concealing their insurance status.  Coverage gains may therefore be less than official estimates suggest.
  • Evidence is mounting that, despite stiffer penalties than ObamaCare will impose, increasing numbers of people are gaming the individual mandate by only purchasing health insurance when they need medical care. Such behavior could ultimately cause the “private” insurance market to collapse.

Nevertheless, the Klein/Cohn thesis is basically that costs have been climbing and employers have been dropping/curtailing health benefits for decades.  So you can’t blame that stuff on RomneyCare.  We should instead be thankful that Massachusetts enacted a new raft of government price controls, mandates, and subsidies to protect residents from those features of “the American health-care system.”

The only problem is that “the American health-care system” is the product of the old raft of government price & exchange controls, mandates, and subsidies.  The largest purchaser of medical care in the country (and the world) is MedicareMedicaid is second.  The Left complains so much about fee-for-service medicine fueling rising health care costs and reducing quality, you’d never know that their beloved Medicare program is the primary reason for its dominance.  Likewise, the reason why employers are dropping and curtailing coverage is that the government turned the private health insurance market into an unsustainable employment-based system that is doomed to unravel.  Cohn’s book documents the inhumanity of that system so well, you’d think it would sour him on the sort of centralized planning that created it.  I could go on…

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.

You Can Laugh All You Want To, But I’ve Got My Philosophy

There’s an interesting back-and-forth between Dan Foster at National Review and Ezra Klein at the Washington Post over whether there’s a symmetry between libertarian (or conservative) preference for smaller government and progressive advocacy for a larger or more active one.  Ezra wants to maintain that the former is “philosophical”—one might use the more loaded “ideological”—in a way that the latter is not.  And his argument has some intuitive appeal, but I think ultimately misfires:

But like a lot of people, I actually don’t have an abstract preference for either bigger government or smaller government. If we made the Defense Department a lot smaller, or reformed the health-care system so that we were getting a deal more akin to European countries, or got the federal government out of farm subsidies, that would be fine with me, even as the government would shrink. A lot of conservatives believe, I think, that their philosophical preference for small government is counterbalanced by other people’s philosophical preference for big government. But that’s not true: Their philosophical preference for small government is counterbalanced by other people’s practical preference for larger government in certain areas where it seems to make sense.

Now, this much I take to be true: Ezra and other progressives, talk show rhetoric notwithstanding, don’t have some abstract desire to increase the size and power of government independently of particular functions they want government to serve.  But that doesn’t mean his contrast between his “practical preference” for larger government “where it seems to make sense” and the “philosophical preference for small goverment” will fly.  As long as we’re invoking philosophy, it may be useful to deploy the hoary distinction ethicists often make between teleological and deontological principles—very crudely, the distinction between principles that specify ends or goals, and principles that specify rules that constrain our pursuit of ends or goals.

In a teleological frame, the asymmetry Ezra is positing makes a certain amount of sense. Progressives’ desire for larger government is mostly instrumental, while libertarians and conservatives seem to treat smaller government as an end in itself. But I think this is somewhat misleading. You could also say that Ezra and I both favor a government exactly large enough to accomplish its legitimate functions, albeit with very different views of what those functions are. In part this difference is “practical”—or at any rate, empirical—on both sides: Neither of us, presumably, think the government should squander taxpayer money on ineffective programs, but we have different background views about the relative effectiveness of government and civil society at achieving worthy aims.

But flipping explicitly into a deontological frame, we can see another difference—and here I think there is a real symmetry. You could say that where we differ is in how much weight we give the citizen’s prima facie claim against coercive interference. I think that claim ought to have quite a lot of weight, such that there are a relatively small number of public goods sufficiently vital to justify overriding the presumption against interference. Even assuming we agreed on the probable utilitarian benefit of some particular government program, I think it is fair to say Ezra gives a lot less presumptive weight to such claims. If you do not see anything seriously morally problematic about compelling people to contribute to projects and goals that (granting assumptions about efficacy, for the sake of argument) seem broadly worthy, you’ll be inclined to see government as an all-purpose mechanism for remedying a whole array of social problems. Which particular problems justify larger government will then be determined by “practical” considerations, but the background premise about the weight of the claim against compulsion is going to be exactly as “philosophical” for the progressive as for the libertarian or the conservative.

Anderson: “Opposition to ObamaCare Is Rock-Solid”

The Washington Post’s Ezra Klein looks at the May/June polling data from Pollster.com (below) and concludes ObamaCare is “getting more, not less, popular.”

At The Weekly Standard, Jeffrey H. Anderson explains how that changing trendline reflects not a shift in public sentiment, but the fact that the polls conducted in May and June are fewer and less reliable.

The Senate Bill Would Increase Health Spending

Ezra Klein quotes the Congressional Budget Office’s latest cost estimate of the Senate health care bill when he writes:

“CBO expects that the legislation would generate a reduction in the federal budgetary commitment to health care during the decade following 2019,” which is to say that this bill will cover 30 million people but the cost controls will, within a decade or so, leave us spending less on health care than if we’d done nothing.  That’s a pretty good deal. But it’s not a very well-understood deal.

Indeed, because that’s not what the CBO said.

First, the CBO said the “federal budgetary commitment to health care” would rise by $210 billion between 2010 and 2019 under the Senate bill.  Then, after 2019, it would fall from that higher level.  And it could fall quite a bit before returning to its current level.

Second, the “federal budgetary commitment to health care” is a concept that includes federal spending on health care and the tax revenue that the federal government forgoes due to health-care-related tax breaks, the largest being the exclusion for employer-sponsored insurance premiums.  If Congress creates a new $1 trillion health care entitlement and finances it with deficit spending or an income-tax hike, the “federal budgetary commitment to health care” rises by $1 trillion.  But if Congress funds it by eliminating $1 trillion of health-care-related tax breaks, the “federal budgetary commitment to health care” would be unchanged, even though Congress just increased government spending by $1 trillion.  That’s what the Senate bill’s tax on high-cost health plans does: by revoking part of the tax break for employer-sponsored insurance, it makes the projected growth in the “federal budgetary commitment to health care” appear smaller than the actual growth of government.

Third, the usual caveats about the Senate bill’s Medicare cuts, which the CBO says are questionable and Medicare’s chief actuary calls “doubtful” and “unrealistic,” apply.  If those spending cuts don’t materialize, the “federal budgetary commitment to health care” will be higher than the CBO projects.

Fourth, Medicare’s chief actuary also contradicts Klein’s claim that the Senate bill would “leave us spending less on health care than if we’d done nothing.”  The actuary estimated that national health expenditures would rise by $234 billion under the Senate bill.

And really, Klein’s claim is a little silly.  Even President Obama admits, “You can’t structure a bill where suddenly 30 million people have coverage and it costs nothing.”