Topic: Cato Publications

A Turn of the Revolving Door

According to the Hill Climbers section of today’s Roll Call,

Brian Zimmer is saying goodbye to Capitol Hill to join the American Association of Motor Vehicle Administrators.  According to a statement, AAMVA is an association that “actively promotes traffic safety and uniformity among North American jurisdictions.” Zimmer starts today as the company’s new senior vice president of identity management.
Before making the jump, Zimmer worked for the past five years as senior policy adviser and investigator for the House Judiciary Committee. There he helped investigate and conduct the committee’s oversight on issues such as fraud prevention, border security and counterterrorism, among others. 

Specifically, Brian was the Judiciary Committee’s lead staffer on the REAL ID Act, our national ID law.  He is a committed and motivated proponent of that cause.

AAMVA is well recognized (by those who care to follow these issues) as a proponent of driver regulation, national IDs, and even internationally uniform ID systems.  Since at least the late 1930’s AAMVA has been pushing regulatory control of drivers and driving.  As I note in my book, Identity Crisis, “Before September 11, 2001, AAMVA promoted a national identification card as a solution to illegal immigration.  After September 11, 2001, it promoted a national identification card as a solution to terrorism.  If national identification cards are a hammer, AAMVA sees every public policy problem as a nail.”

AAMVA collects about $1 per driver per year (roughly $13 million) for its part in administering the Commercial Drivers License Information System.  AAMVA would make much more as the administrator of databases required by the REAL ID Act.

Brian is a nice guy and, as I say, dedicated to his cause.  His new employment provides a window into AAMVA’s role in the national ID debate.

The GOP’s Failed Anti-immigration Strategy

The Wall Street Journal published a great lead editorial this morning (subscription required) on the GOP House leadership’s losing campaign strategy of using immigration as a “wedge issue.” The strategy obviously failed.

As the Journal’s editorial staff observed:

Republicans on Tuesday managed both to lose their majority in Congress and alienate a fast-growing bloc of Latino swing voters. Other than that, the House GOP strategy of trying to save itself by bucking President Bush and using immigration as a wedge issue worked pretty well.

Republicans can’t say they weren’t warned. Like trade protectionism, the immigration issue is the fool’s gold of American politics. Voters like to sound off to pollsters about immigrants, yet they pull the lever with other matters foremost in mind. Elections seldom if ever turn on immigration, and the GOP restrictionist message so adored by talk radio, cable news and the nativist blogosphere once again failed to deliver the goods.

Such GOP anti-immigration crusaders as J.D. Hayworth of Arizona and John Hostettler of Indiana were tossed out of office by wide margins. Exit polls suggest that Republicans suffered a sizeable drop in support from Hispanic voters turned off by the harsh Republican rhetoric aimed at Hispanic immigrants.  

Of course, I call it a great editorial because it and this week’s election returns confirm my own warnings to Republicans about the dangers of running as the anti-immigration party (here and here).

Although the election results were not good news on free trade and other issues, the new Congress will probably be more open to the kind of real immigration reform the Cato Institute has been advocating.

Jeff Flake, Take (Another) Bow!

Further to Tom’s post on Monday, our friend Jeff Flake (R–AZ) has written an excellent op-ed in today’s Wall Street Journal (subscription required) on the need for Republicans to apologize for betraying their small-government principles. Mr. Flake points to the farm bill, up for renewal next year, as the best opportunity to ” hew back to our [i.e., Republicans’] first principles.”

Yes, please. And may I propose the dairy policy, one of the most egregious examples of Soviet-style intervention, as one of the first to be reformed? Here’s a study I released yesterday on that very topic.

Bravo, Mr. Flake. I wish you the best of luck.

This Incumbent Was Protected from the Wave

Last week I wrote about the ways the Bipartisan Campaign Reform Act of 2002 made Christopher Shays’ re-election bid more likely.

Yesterday, Chris Shays bucked the national trend and won re-election despite having trailed in the polls for some time. He won by 3 percentage points of the vote. In 2004, a better year for Republicans, Shays won by 4 points.

Perhaps he should send a thank you note to the sponsors of the law, Senators John McCain and Russell Feingold as well as Rep. Martin Meehan and … Rep. Christopher Shays.

Ponnuru Misses the Point

In his cover story for the new issue of National Review, “Conservatives on the Couch” (not yet available online), Ramesh Ponnuru devotes considerable ink to debunking the recent Cato study by David Boaz and David Kirby on “The Libertarian Vote.” I think he misses the point.

Here’s Ramesh:

David Boaz and David Kirby … have recently made an ambitious attempt to claim that libertarians are the swing voters at the center of American politics. Their chief evidence: The 15 percent of voters whom they identify as broadly “libertarian” gave Bush 72 percent of their votes in 2000 and only 59 percent in 2004….

They seem unaware that their data tell more against than for their thesis. The electorate as a whole swung toward Bush during those years: He increased his percentage of the overall vote from 48 to 51. Libertarians swung one way; the remaining 85 percent of the electorate swung the other way, and swung far enough to overwhelm the libertarians. Could it be that the same actions that alienated libertarians won Bush the support of these other voters? Well, yes, it could.

For those keeping score at home, here’s how my card reads: Ramesh, 1; Straw Man, 0!

Ramesh does a fine job of marshaling evidence in support of the utterly obvious. Of course libertarians aren’t the kingmakers of American politics. Of course it’s possible to ignore particular libertarian concerns and profit electorally. If those things weren’t true, much of American history would be inexplicable.

As I read it anyway, “The Libertarian Vote” makes more modest claims than those Ramesh seeks to refute. And Ramesh’s critique leaves those modest but important claims intact.

The fact is we don’t know why libertarian support for Bush declined between 2000 and 2004. Was it the war? Big spending? Social issues? The overall stink of incompetence? Or some or all of the above? We just don’t know.

We therefore don’t know what overlap there is between the issues that underlay reduced libertarian support and those that underlay increased overall support. It’s possible that an alternative-universe Bush administration could have taken positions that maintained or increased libertarian support while increasing support from other quarters as well – thus producing an even bigger victory in 2004 than the one that occurred here (which was pretty anemic for an incumbent with an expanding economy).

Here’s what we do know after reading “The Libertarian Vote.” The group of broadly libertarian, “economically conservative but socially liberal” voters makes up around 15 percent of the population. Historically, these voters have strongly favored Republicans, but their level of support fluctuates and has been trending down of late.

And what does that mean? It means that Democrats might be able to capitalize on those recent trends if they made any concerted effort at all to appeal to libertarians. And by so capitalizing, they might be able to change the outcome of close elections.

And if Democrats started winning by attracting libertarians who used to vote GOP – as it appears they have begun doing in Western states, according to Ryan Sager – libertarians could actually end up as a bona fide swing constituency, actively courted by both sides. And wouldn’t that be fun?

We’re not there yet. Right now, the libertarian vote is only a potentially important swing constituency. It has come into play for reasons we don’t understand well. But it’s big enough, and volatile enough, that it could lend decisive aid to either party that courts it.

Ramesh’s message seems to be that small-government types are unpopular nerds who should content themselves with being allowed to run with the social-conservative cool kids. (Yeah, I know that sounds funny – the conservative cool kids, I mean, not the libertarian nerds.)

I say libertarians can do better than that. And the data in “The Libertarian Vote” show that isn’t just an idle fantasy.

P4P All Over the Private Sector

At yesterday’s Cato policy forum on pay-for-performance (P4P) in Medicare, I argued the Medicare bureaucracy should stay out of P4P largely because Medicare would ruin the idea. A Medicare-administered P4P program would be less flexible than private efforts, more likely to harm patients, and the very providers that P4P aims to discipline would have way too much say in a Medicare P4P program. I recommended confining P4P to private Medicare Advantage health plans. Read my full argument here.

Harvard’s David Cutler argued that Medicare should get involved in P4P because private insurers didn’t have the purchasing power to really force providers to change. At the time, I was unaware of this study by Meredith Rosenthal and her colleagues in this week’s New England Journal of Medicine. They report:

More than half the HMOs, representing more than 80% of persons enrolled, use pay for performance in their provider contracts. Of the 126 health plans with pay-for-performance programs, nearly 90% had programs for physicians and 38% had programs for hospitals.

That probably doesn’t match Medicare’s purchasing power. But it does suggest that P4P can gain a toehold through the private sector.

When Patients Change, Do Providers Change Too?

Harvard’s David Cutler visited Cato yesterday to participate in a small group discussion about cost-effectiveness in medicine, and also in a panel on improving quality in Medicare. (You can watch the latter event here in a couple of days.) My colleague Arnold Kling blogs about issues discussed at both events. 

I am struck by one issue that emerged, which has to do with price-sensitivity, provider behavior, and health outcomes. Cutler argued that when patients are more price-sensitive (i.e., when they have to pay for more of the cost of their medical care), they tend to cut back both on care that would have done nothing for them, and on care that would have helped them. He postulates that if we were to move all Americans into health savings accounts (HSAs), thereby making patients more price-sensitive, we would see worse health outcomes than we see now. 

I am skeptical of that prediction. I think that if the move to HSAs were confined to a small, randomly selected subset of the population (call it “Rand II”), Cutler’s prediction would be more plausible — though by no means certain. There is precious little evidence that suggests — and it does no more than suggest — that for some patients, greater price-sensitivity leads to worse health outcomes. 

However, even if we assume that Rand II would show that greater price-sensitivity leads to worse health outcomes, it does not follow that we would get the same result were the entire population made more price-sensitive. The reason is that with a population-wide shift, the supply side of health care markets would respond to the enormous change on the demand side. Faced with patients who are less eager to consume medical care, providers would have to do a lot more to sell their services, including:

  • conducting research on the usefulness of their services,
  • improving the quality of their services,
  • lowering their prices, and
  • educating patients about the value of their services.

These responses should enable patients to make smarter decisions about what to consume and what to avoid. Instead of having patients cut back equally on beneficial and useless care, they would cut back on useless care more, having more help discerning between the two. Downward pressure on prices should make cutting back on beneficial care even less frequent.

MIT economist Amy Finkelstein demonstrates that the supply side of medical care does respond to demand-side changes. For 30 years, economists believed that the expansion of health insurance (which reduced price-sensitivity) had a relatively small impact on the growth of health spending. That belief was based on the effects of a demand-side study (Rand I), which was too small to induce or measure any supply-side responses to the change in price sensitivity. Using a data set that does capture and allow her to measure supply-side responses, Finkelstein estimates that the effect that the expansion of health insurance had on health spending is six times greater than the demand-side-only experiment Rand I suggests. 

Casual observation suggests that supply-side responses are helping price-sensitive patients make better choices right now. At the same time that HSAs and other insurance options are making millions of patients more price-sensitive, insurers and entrepreneurs are furnishing more of the price and quality information that patients need.

It would be foolish to claim that the supply-side response to price-sensitive consumers would be so great that patients would have perfect information and would never make mistakes. Yet most opponents of making patients more price-sensitive make the equally foolish assumption that there would be no supply-side response to the new incentives coming from the demand side. I say “most” because Cutler and others are not in this group. If I understood Cutler, he acknowledges that there will be such supply-side responses, and that we have no way of knowing whether or how much they would improve health outcomes.

True enough. But it’s something like 50 percent of the debate over HSAs and health outcomes. T’would be nice to have opponents of HSAs and the like acknowledge and engage it.