Topic: Health Care

Live Blog of the 2013 State of the Union Address and the GOP Response

Please join us at 9:00PM ET on Tuesday, February 12, for live commentary during President Obama’s State of the Union address, the GOP response by Sen. Marco Rubio, and the Tea Party response by Sen. Rand Paul. Here is our panel of policy experts by research area:

General Comment and the Presidency:

Banking and Financial Regulation:

  • Mark Calabria, Director of Financial Regulation Studies (@MarkCalabria)

Infrastructure and Fiscal Policy:

Law and Civil Liberties:

Telecom and Information Policy:

  • Jim Harper, Director of Information Policy Studies (@Jim_Harper)

Health Care:

Immigration:

Education:

  • Andrew Coulson, Director - Center for Educational Freedom (@Andrew_Coulson)
  • Neal McCluskey, Associate Director - Center for Educational Freedom (@NealMcCluskey)

Energy and Environment:

  • Patrick J. Michaels, Director - Center for the Study of Science (@CatoMichaels)
  • Chip Knappenberger, Assistant Director - Center for the Study of Science (@PCKnappenberger)

Foreign Policy and National Security:

Follow their comments directly on Twitter, or come back to this page at 9:00 PM ET on Tuesday, February 12, to join us. We look forward to having you, and sharing our insights with you.

You can also follow the conversation on Twitter by following @CatoInstitute and the hashtag #SOTU.

Also watch Cato’s Libertarian State of the Union.

Matt Yglesias Cools Out the Marks

Ben Smith has a mostly excellent piece titled, “Obama Prepares to Screw His Base”:

[T]he health care overhaul known as ObamaCare [is] calculated to screw his most passionate supporters and to transfer wealth to his worst enemies.

The passionate supporters are the youth, who voted for him by a margin of 60% to 36%, according to exit poll samples of people 29 and under. His enemies are the elderly: Mitt Romney won 56% of the votes from people 65 and over…[W]hat follows may come as an unpleasant surprise to many of the president’s supporters. The provisions required to make any sort of health insurance plan work — not just ObamaCare, but really any plan of its sort — require healthy young people to pay more in health insurance than they consume in services, while the elderly…consume far more than they pay in…[T]his year will be spent laying plans to shift the burden further toward the young…

And so this vast transfer or resources from young to old — just the latest in a long line of these transfers — hasn’t been discussed much because it is totally uncontroversial.

The piece falls shy of totally excellent because Smith incorrectly asserts, contrary to the economics literature, that young people have to subsidize old people for health insurance markets to work. Smith correctly notes that ObamaCare screws young people, but thinks that’s unavoidable, if unfortunate. Since there’s no reason to screw young people at all, ObamaCare is even worse than Smith portrays it.

But Matt Yglesias takes the cake. ObamaCare does not screw the young, he writes. Sure, millions of young adults will pay more for health insurance, even after accounting for ObamaCare’s subsidies. But young adults shouldn’t sweat the triple-digit premium hikes ObamaCare forces them to pay solely for the benefit of subsidizing older people who have more resources than they do. Why? Because today’s young adults will benefit later when ObamaCare does the same for them at the expense of subsequent generations. You know, if they don’t die first. What could go wrong?  

Social scientists have a term to describe the role that people like Yglesias play in a confidence game. It’s called “cooling out the mark.” In his classic 1952 article, sociologist Erving Goffman explains. See if you can find any similarities:

The confidence game – the con, as its practitioners call it – is a way of obtaining money under false pretenses by the exercise of fraud and deceit…

The typical play has typical phases. The potential sucker is first spotted and one member of the working team (called the outside man, steerer, or roper) arranges to make social contact with him. The confidence of the mark is won, and he is given an opportunity to invest his money in a gambling venture which he understands to have been fixed in his favor. The venture, of course, is fixed, but not in his favor. The mark is permitted to win some money and then persuaded to invest more. There is an “accident” or “mistake,” and the mark loses his total investment. The operators then depart in a ceremony that is called the blowoff or sting. They leave the mark but take his money. The mark is expected to go on his way, a little wiser and a lot poorer.

Sometimes, however, a mark is not quite prepared to accept his loss as a gain in experience and to say and do nothing about his venture. He may feel moved to complain to the police or to chase after the operators. In the terminology of the trade, the mark may squawk, beef, or come through. From the operators’ point of view, this kind of behavior is bad for business. It gives the members of the mob a bad reputation with such police as have not yet been fixed and with marks who have not yet been taken. In order to avoid this adverse publicity, an additional phase is sometimes added at the end of the play. It is called cooling the mark out. After the blowoff has occurred, one of the operators stays with the mark and makes an effort to keep the anger of the mark within manageable and sensible proportions. The operator stays behind his team‑mates in the capacity of what might be called a cooler and exercises upon the mark the art of consolation. An attempt is made to define the situation for the mark in a way that makes it easy for him to accept the inevitable and quietly go home. The mark is given instruction in the philosophy of taking a loss.

So remember, young voters. ObamaCare doesn’t screw you. ObamaCare is good for you.

See you next time.

Obamacare’s Shell Games Collectivize Our Consciences

Facing increasing losses in federal courts over Obamacare’s contraceptive mandate, the Department of Health & Human Services last week promulgated a rule to expand exemptions for religious nonprofits. That sounds good, but what the government is actually doing is a sort of accounting shell game: employers will no longer have to pay for the products/services to which they objects, but the government requires them to contract with an insurance company that the government then requires to provide these products/services to employees who want them “for free.”

As Yuval Levin put it, “If religious people thought about their religious obligations the way HHS lawyers think about the law, this might just work. But they don’t.” Matt Bowman, an attorney litigating some of these cases, makes some amusing analogies to illustrate the point:

Suppose the government decides that college students need access to pornography for their sexual health. It forces all colleges to give their students a free subscription to the Playboy Channel. Christian colleges object. So the government says it will merely force those colleges to give their students a subscription to cable television, and then it will force that cable company to give those students a free subscription to the Playboy Channel. Why would the Christian colleges be content with this arrangement?

Imagine that the government wishes to empower Second Amendment rights. It pairs employers with local families struggling with mental illness and requires the employers to provide the families with free handguns. Religious groups object. So the government forces the religious groups to give people with mental illness a membership at a shooting range, and then forces the shooting ranges to provide those people with free handguns as a benefit of membership.

Perhaps the government decides that Americans need to just calm down, especially religious fanatics. It forces employers to supplement the water supply in their buildings with sedatives. Religious groups object. So the government forces the religious groups to maintain an account with the water company, and then forces the water company to put sedatives in the religious groups’ water supply.

The new accounting gimmick contraceptive-mandate exemption simply betrays contempt for anyone, religious or otherwise, who doesn’t want to pay for birth control pills. (I should note that I have no moral objection to contraceptives or the other pills at issue in this mandate; it’s the mandate itself that’s a problem.) And remember that there’s no question that proposed exemption doesn’t help objecting for-profit businesses, such as Hobby Lobby, one wit.  And that’s a shame. 

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.

Ted Olson on John Roberts’ Saving Construction of ObamaCare

At a recent legal conference, former Solicitor General (and Cato Institute board member) Ted Olson offered this slightly nerdy take on Chief Justice John Roberts’ saving construction of ObamaCare’s individual mandate:

Roberts’ support for the individual mandate brings to mind the Higgs boson — it can’t be seen, it disappears upon occurrence, and it’s the God particle that controls everything in the universe.

Hat tip: Louise Bennetts.

ObamaCare’s Triple-Digit Premium Hikes Dramatize the Need for Repeal

In 2010, the Obama administration excoriated health insurance companies for “rate hikes as high as 39 percent.” HHS Secretary Kathleen Sebelius wrote:

This is unacceptable…

President Obama has offered a health insurance reform proposal to help working families and small business owners.  It will hold insurance companies accountable by laying out common-sense rules of the road to keep premiums down…

Reform will change the rules and help stop exorbitant increases.

And the President’s plan will help reduce costs…

According to the Chicago Sun-Times, that double-digit rate increase “helped dramatize the need for regulation.”

That episode came to mind this morning when I read about a survey of health insurers that shows ObamaCare will neither “keep premiums down” nor “stop exorbitant increases” nor “reduce costs”:

The survey, fielded by the conservative American Action Forum and made available to POLITICO, found that if the law’s insurance rules were in force, the premium for a relatively bare-bones policy for a 27-year-old male nonsmoker on the individual market would be nearly 190 percent higher…

Most other studies have tried to estimate average premium increases, which have ranged anywhere from negligible to 85 percent and higher. This survey looks at individual examples in specific markets to show the itemized impact of the major Obamacare reforms…

On average, premiums for individual policies for young and healthy people and small businesses that employ them would jump 169 percent, the survey found.

These findings are in line with projections by neutral observers and even ObamaCare supporters like MIT economist Jonathan Gruber that the law will increase premiums for some individuals and small businesses by more than 100 percent. 

If double-digit premium increases dramatized the need for regulation, do triple-digit increases dramatize the need for its repeal?

Politico offers a strange rationalization for these rate hikes:

The increase will most likely be substantial for “a slice of the younger population,” said Massachusetts Institute of Technology health economist Jon Gruber, a supporter of the health law who has studied its impact on premiums.

And those are the people who, before Obamacare, benefited from insurers’ ability to charge older, sicker people much higher rates — or deny them coverage altogether — practices that have kept premiums for the young low.

Set aside the fact that these rate hikes effectively tax young workers to subsidize older workers who generally have higher incomes. According to this theory – I can’t tell if it came from Gruber or Politico – those young workers are today unjustly enriched because they’re not being robbed.