Archives: 03/2017

Poll: Support for Obamacare’s Most Popular Provisions Plummet if Quality of Care Threatened

Support for the ACA’s community-rating provisions flips from 63%-33% support to 60%-31% opposed if it harms the quality of health care. 55% say more free-market competition not government management would best deliver high-quality affordable health care. FULL RESULTS (PDF)

Most polling of the Affordable Care Act finds popular support for many of its benefits when no costs are mentioned. However, a new Cato Institute/YouGov survey finds that support plummets, even among Democrats, if its popular provisions harm the quality of health care. The poll finds that risks of higher premiums, higher taxes, or subsidies to insurers are less concerning to Americans than harm to the quality of care. 

By a margin of 63% to 33%, Americans support the ACA’s community-rating provision that prevents health insurers from charging some customers higher rates based on their medical history. However, support flips with a majority opposed 60%-31% if the provision caused the quality of health care to get worse.

Majorities also come to oppose the ACA’s community-rating provision if it increased premiums (55% oppose, 39% favor), or raised taxes (53% oppose, 40% favor). However, threats to the to quality of care appear to be a pressure point for most Americans.

State Department Spending Triples

President Trump is reportedly planning to cut the Department of State’s budget by 37 percent. I’m not an expert on the department’s activities, but it would seem ripe for cuts given the large run-up in spending in recent years.

The chart shows Department of State outlays since 1970 in constant 2016 dollars. Real spending has more than tripled the past 16 years—from $9.5 billion in 2000 to $30.9 billion in 2016. The data comes from President Obama’s last budget. You can chart spending on federal departments and agencies here at DownsizingGovernment.org.

The Trump administration apparently wants to make budget room for Department of Defense spending increases, but the Pentagon is also bloated with inefficiency, as discussed here, here, and here.

Race and Redistricting Back In Court: Bethune-Hill v. Va. State Bd. of Elections

The Supreme Court in the 1990s established that “a racially gerrymandered redistricting scheme… is constitutionally suspect” under the Equal Protection Clause. Today’s more-or-less-unanimous decision in Bethune-Hill v. Virginia Board of Elections confirms that the Court is not prepared to back off or cut corners on that principle.

In particular, the Court unanimously found that a district court had been too indulgent in reviewing Virginia officials’ race-conscious drawing of lines for legislative districts. While the Court permits some race-conscious line drawing in order to meet the requirements of the federal Voting Rights Act, this is not a blank check. “Racial gerrymandering, even for remedial purposes, may balkanize us into competing racial factions,” warned Justice Sandra Day O’Connor in the first case in this series, Shaw v. Reno (Shaw I, 1993).

In that 1993 case, O’Connor and her colleagues were reviewing a set of North Carolina districts so bizarre in shape that their tactical purpose could scarcely be denied with a straight face. Today’s ruling clarifies, though there had not been much doubt before, that when there is other evidence of racial motivation, the process does not escape Equal Protection scrutiny just because the shape of districts appears normal and they do not visibly violate other sound principles of districting. 

Justice Alito in a separate and Justice Thomas in a partial concurrence would have applied even tougher scrutiny. Overall, however, the Court spoke with much unity. And that is not something to take for granted on this subject. In both Shaw v. Reno (1993) and Miller v. Johnson (1995), four dissenting Justices from the liberal wing disapproved of Equal Protection scrutiny on varying rationales. In a notably vicious editorial after Shaw I, the New York Times assailed O’Connor personally over what it saw as “a full-scale assault on the Voting Rights Act” intended to “punish” blacks and “sustain all-white politics.” 

Today – despite some academic opinion that still yearns to go back to the days when racial gerrymandering was A-OK when done with suitably progressive motives – all eight sitting members of the Court, liberal wing included, appear content to apply at least the Shaw-Miller level of scrutiny. 

Justice Kennedy wrote today’s opinion, confirming once more that he stands at the center of gravity of today’s Court on redistricting issues. Much of the speculation these days is whether Kennedy is prepared to join the liberal wing in disapproving gerrymandering done for political (typically party- and incumbent-protective), as distinct from racial, motives. By coincidence, for those interested in these issues, I have a chapter in the new 8th edition of Cato’s Handbook for Policymakers on the topic of political gerrymandering, with advice on how best to reduce its prevalence at the state level. 

Trump’s Bad Economic Reasoning on Infrastructure

Last night’s address to Congress by President Trump was devoid of detail on infrastructure investment. But in justifying his desire to harness $1 trillion of public and private funds for “new roads, bridges, tunnels, airports and railways”, the President used two lines of bad economic reasoning sadly all too prevalent in public debate on this issue.

First was to invoke the building of the interstate highway system. “The time has come,” Trump declared, “for a new program of national rebuilding.” The implication: the interstate highway system was good for the economy, so we should invest more in roads today - a common rhetorical technique, but one which confuses average with marginal.

Previous economic research has indeed found that the construction of the interstate highway system substantially boosted productivity for industries associated with road use. But the same research finds those benefits to be largely one-offs, meaning this analysis does nothing to inform us about new decisions. In fact, more recent work has found that too many new highways have been built between 1983 and 2003, and that marginal extensions to the highway system tend not to increase social welfare, because the cost savings of reducing travel times are small relative to incomes and prices.

In other words, building a highway system can boost growth. Building a second highway system? Not so much. Rather than appealing to grand projects based on historical experience, all new government projects should stand up on their own merits – ideally having high benefit to cost ratios and being things that would not be undertaken by the private sector.

The second mistake was to highlight “creating millions of new jobs” as an aim or positive of any infrastructure spending. When the government is investing to build something, it should aim to do so most efficiently. “Jobs” in this sense are a cost, not a benefit, and ones “created” only come through the diversion of resources and opportunities in other parts of the economy.

Upon visiting an Asian country in the 1960s, Milton Friedman is frequently quoted as reacting to the absence of heavy machinery in a canal build by asking why the project was being undertaken by men with shovels. Upon being told it was a “jobs program,” he is said to have remarked: “Oh, I see. I thought you were trying to build a canal. If you really want to create jobs, then by all means give these men spoons, not shovels.”

If one is concerned with improving the economic growth potential of the economy, then you would base both the selection of projects and the means of undertaking them according to that objective. Sadly, when governments are involved, other ambitions (be it stimulating particular regions, appeasing certain interests, obtaining political prestige or facilitating observable jobs) tend to interfere with the stated aim. The constant talk of the benefits of wise, productive investment is an ambition, rather than something we should expect.

Refugees, Immigration, and the Trolley Problem

During the presidential campaign Donald Trump’s son, Eric Trump, tweeted a picture of a bowl of Skittles candies along with the caption: “If I had a bowl of skittles and I told you just three would kill you. Would you take handful? That’s our Syrian refugee problem.”

Trump’s tweet generated backlash from many corners but the general logic of this vivid metaphor continues to resonate for many, despite research that demonstrates that the risk of an American dying in a terrorist attack carried out by refugees and immigrants in the United States is astonishingly low. For many Americans, the prospect of just one bad skittle overwhelms a more rational calculation embracing both immigration’s costs and benefits.

But perhaps a different vivid mental picture can help people see the immigration question in a new light.

The trolley problem is a famous thought experiment in ethics. The general form of the problem (quoted here from Wikipedia) is this:

There is a runaway trolley barreling down the railway tracks. Ahead, on the tracks, there are five people tied up and unable to move. The trolley is headed straight for them. You are standing some distance off in the train yard, next to a lever. If you pull this lever, the trolley will switch to a different set of tracks. However, you notice that there is one person on the sidetrack. You have two options:

  1. Do nothing, and the trolley kills the five people on the main track.
  2. Pull the lever, diverting the trolley onto the sidetrack where it will kill one person.

This is a tough scenario for sure. Do you believe that pulling the lever is the best option? What is your justification for that choice?

Surveys have shown that around 90% would make the difficult decision to pull the lever to save the five people. The justification for most people is straightforward: saving five lives is better than saving one life. But studies also show that it matters a great deal who that one person is. For example, if the person happens to be the respondent’s relative or loved one, a respondent is far less likely to indicate he or she would pull the lever.

Book Forum: The Ukraine Crisis and U.S.-Russian Relations

Nearly three years ago, Ukraine’s Kremlin-backed president fled the country’s capital amidst massive anti-government protests. The series of events to follow would alter the geopolitical landscape of post-Soviet Eurasia, destabilize security within the wider region and pose a major challenge for U.S.-Russia relations.

Following an unrecognized referendum in eastern Ukraine, Russia proceeded in its annexation of the Crimean peninsula in a brazen act transgressing the notion of Westphalian sovereignty. The United States and the European Union responded by imposing sanctions on Russia, with debatable efficacy, while two ceasefire agreements have failed to end a protracted and bloody conflict on the ground.

Against this backdrop, the Trump administration has indicated a willingness to lift Russian sanctions in order to improve bilateral relations—a move which would be unpopular in Congress. Simultaneously, there is continued insistence from the United States and Europe that Russia must return control of the Crimea to Ukraine—a stipulation which Russia refuses to consider. Where do U.S.-Russia relations go from here?

Prior to looking into the policy options, an upcoming Book Forum presenting the recently released book Everyone Loses: The Ukraine Crisis and the Ruinous Contest for Post-Soviet Eurasia (Routledge, January 2017) will first examine how U.S.-Russian relations arrived at such a precarious point in the first place.  

The book’s authors, Timothy J. Colton (Morris and Anna Feldberg Professor of Government and Russian Studies, Harvard University) and Samuel Charap (Senior Fellow for Russia and Eurasia, International Institute for Strategic Studies; Former Senior Advisor, U.S. Under Secretary of State for Arms Control and International Security), argue that a series of grave strategic miscalculations, resulting from years of zero-sum behavior on the parts of both Russia and the United States, have destabilized the post-Soviet Eurasian sphere to the detriment of the West, Russia and the countries caught in the midst. With regional and international security now deteriorated and all parties worse off, Colton and Charap conclude that all governments must commit to patient negotiation aimed at finding mutually acceptable alternatives, rather than policies aimed at securing one-sided advantages.

Please join us for what is sure to be an insightful and comprehensive foray into the roots of the Ukraine crisis during Cato’s Book Forum on March 10th, featuring co-author Samuel Charap with comments provided by Emma Ashford, Cato Institute Research Fellow. You are invited to register for the event here.

WSJ: How ObamaCare Punishes the Sick

In today’s Wall Street Journal, I discuss new economic research showing ObamaCare is making health insurance worse for patients with high-cost medical conditions.

Republicans are nervous about repealing ObamaCare’s supposed ban on discrimination against patients with pre-existing conditions. But a new study by Harvard and the University of Texas-Austin finds those rules penalize high-quality coverage for the sick, reward insurers who slash coverage for the sick, and leave patients unable to obtain adequate insurance…

If anything, Republicans should fear not repealing ObamaCare’s pre-existing-conditions rules. The Congressional Budget Office predicts a partial repeal would wipe out the individual market and cause nine million to lose coverage unnecessarily. And contrary to conventional wisdom, the consequences of those rules are wildly unpopular. In a new Cato Institute/YouGov poll, 63% of respondents initially supported ObamaCare’s pre-existing-condition rules. That dropped to 31%—with 60% opposition—when they were told of the impact on quality.

Republicans can’t keep their promise to repeal ObamaCare and improve access for the sick without repealing the ACA’s penalties on high-quality coverage.

The lesson is clear. To repeal ObamaCare, opponents need to talk to voters about how the law is reducing the quality of health insurance and medical care for the sick.

Read the whole thing.

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