Tag: Ted Cruz

No ‘Freedom Option’ in the Revised Senate Health Care Bill

The other day, I wrote a piece lauding an amendment Sen. Ted Cruz (R-TX) was proposing to add to the Senate GOP’s health care bill. Cruz called it the Consumer Freedom Amendment. If insurers offered two ObamaCare-compliant plans to all comers, the Cruz amendment would have freed them to sell–and freed consumers to purchase–health-insurance plans that did not comply with those regulations. The legislative language I saw appeared to free consumers, not from all the regulations I would like, but from enough that it would have made the Senate bill a step in the right direction. It also included more restrictions on the use of this “freedom option” than I would like, but same thing. The changes would have dramatically reduced premiums for consumers. Perhaps more important, it would have offered more comprehensive and more secure coverage to people who develop expensive illnesses than ObamaCare does.

Today, Senate GOP leaders released an updated draft of their health care bill. 

This draft imposes ObamaCare’s “single risk pool” price controls on “freedom option” plans. Long story short, that means there is no “freedom option” in this bill. Insurers probably would not even offer non-compliant plans. If they did, ObamaCare’s “single risk pool” price controls would make secure, guaranteed-renewable health insurance impossible by taxing such plans to death. Here’s how.

  • The “single risk pool” price controls would require insurers to increase premiums for both ObamaCare-compliant plans and non-compliant plans by the same percentage. If claims in the compliant market necessitate a 10 percent increase, while claims in the non-compliant market necessitate only a 6 percent increase, the insurer would have to increase premiums in the former market by too little and/or increase premiums in the latter market by too much.
  • Let’s say insurers split the difference by increasing premiums in both markets by 8 percent. In the second year, insurers would be over-charging consumers in the non-compliant market. The problem would only get worse with time. By year five, the insurer would be overcharging consumers in the non-compliant plans by almost 10 percent. That creates an incentive for the insurer or a competitor to issue new, appropriately priced non-compliant plans that lure the healthy people out of the old non-compliant plans.
  • Consumers who developed expensive illnesses in the first year could not switch to the new non-compliant plans, because insurers would underwrite them and charge them an even higher premium. So those folks would stay in the old non-compliant plans until the hidden tax imposed by the “single risk pool” price controls made those plans a worse deal than the heavily subsidized ObamaCare-compliant plans. At that point, those consumers would switch to the ObamaCare-compliant plans. Actually, the effect would be a lot like that of the MacArthur waivers in the House’s health care bill. [Update: Astute reader Doug Badger notes that because the non-compliant plans do not qualify as creditable coverage, people in those plans could not automatically switch to ObamaCare-compliant plans. “They would either have to renew their existing policy, buy another non-ACA-compliant policy, or remain uninsured for a period of six months before enrolling in a policy sold through the Exchange,” he writes. Another option would be for the enrollee (or a parent or spouse) to take a job with health benefits for twelve months and then switch to an ObamaCare-compliant plan. Since employer-sponsored insurance would count as creditable coverage, there would be no waiting period, and while employers may impose waiting periods of up to 90 days for health benefits, the enrollee could keep her non-compliant plan until she is eligible to enroll in the employer plan. To the extent these strategies are feasible, newly sick enrollees in old non-compliant plans would and could migrate to compliant plans. To the extent such strategies are infeasible, the “single risk pool” price controls would create a trifurcated market of (1) healthy people hopping among non-compliant plans and (2) newly sick people stuck in increasingly overpriced non-compliant plans that subsidize (3) people with preexisting conditions in ObamaCare plans. Presumably, however, at a certain point, the costs of remaining in increasingly overpriced non-compliant plans would exceed the costs of those switching strategies.]
  • In other words, secure, long-term, guaranteed-renewable coverage would be impossible, because the “single risk pool” price controls would tax those plans to death.
  • This dynamic would happen even faster if insurers increase both the compliant and noncompliant plan premiums by 10 percent, which they probably would.

I’m not saying there’s no way Senate Republicans can redeem their bill. I have offered ideas that might. But at this point, the Cruz amendment does not redeem or even add to the bill.

I don’t get Republicans’ sudden infatuation with price controls

Socialized Medicine: From Anecdote to Data

Last night’s CNN duel between Senators Bernie Sanders and Ted Cruz on the future of Obamacare was pretty illuminating for a recent arrival to the United States, with Senator Sanders’ playbook all-too-familiar to those of us from the UK.

Sanders wants a single-payer socialized healthcare system in the United States, just as we have in Britain. Any objection to that is met with the claim that you are “leaving people to die.” The only alternatives on offer, you would think, are the U.S. system as it exists now, or the UK system. Sanders did not once acknowledge that the UK structure, which is free at the point of use, inevitably means rationed care, with a lack of pre-screening. He also failed to acknowledge that lower health spending levels (indeed, even public spending on health is lower in the UK than the United States now) are not the same as efficiency—which is about outputs per input.

In the face of anecdote after anecdote about those saved by Obamacare and the virtues of a government-run health system, Cruz countered with some anecdotes from the UK showing the consequences of rationed care: a Scottish hospital turning away pregnant women, a woman in Wales waiting eight hours on the floor for an ambulance to arrive after a fall, and a hospital in Essex canceling life-saving cancer treatment because there were no free beds in intensive care. He could also have talked about the Mid-Staffs scandal, or a recent documentary showing doctors deciding between saving a cancer patient or a pensioner bleeding to death.

Anecdotes are powerful in helping to persuade people, and there are good reasons to use them in debates. Yet they are always susceptible to the charge that all health systems have extreme failures. Perhaps more powerfully then, the inadequacies of the UK system show up systematically in the data about how well conditions are dealt with (data from my former colleague Kristian Niemietz’s reports here and here):

  • In the United States, the age-adjusted breast cancer 5-year survival rate is 88.9 percent, compared with just 81.1 percent in the UK
  • The United States leads the world on the equivalent stat for prostate cancer (97.2 per cent) vs. 83.2 percent in the UK
  • Lung cancer: 18.7 percent in the United States vs. 9.6 percent in the UK; bowel cancer: 64.2 percent vs. 56.1 percent
  • Just in case you think I am cherry picking: U.S. survival rates are also better for leukemia, ovarian cancer, stomach cancer, and liver cancer—all of those for which I can find comparisons
  • The age- and sex-standardized 30-day mortality rate for ischaemic stroke is just 3.6 per cent in the United States vs. 9.2 per cent in the UK; for haemorrhagic stroke, the figures are 22 percent vs. 26.5 percent

I could go on. All of which is to show that your probability of dying from a range of common conditions is much higher in the UK than here. Perhaps that’s why (with no hint of irony) The Guardian’s write-up of a Commonwealth Fund Report suggesting the UK’s health system was “the best in the world” said “the only serious black mark against the NHS was its poor record on keeping people alive.”

The Good News You May Not Have Noticed in This Horrid Election Year

Michael Kinsley’s short oped “And Now For Some Good Newsis one of the most uplifting things I’ve read in a while:

The overwhelming Democratic front-runner is a woman, yet all the questions that used to be raised about whether a woman could be president have disappeared…

The Democratic front-runner’s rival is a Jew, which also has not been an issue…

This election season has seen the president nominate a person who would be the fourth Jew (out of nine justices) on the Supreme Court. The other five seats are filled by Catholics. No fuss at all…

[O]ne of the remaining GOP candidates is Latino, as was another who recently dropped out of the race…[Ted] Cruz still could win the nomination. There was also a black candidate who did well with voters, but the fact that Ben Carson is African-American was simply not an issue…

Most encouraging of all, after an initial explosion of joy and self-congratulation, the fact that our president for the past eight years has been a black man has largely receded into the background.

I plan to return to Kinsley’s op-ed when this election inevitably stoops to yet another new low.

Tax Reform Revenues Wrongly Contrasted with Soaring CBO estimates

CBO Baseline Projected Revenue

When the Brookings Institution and Urban Institute claim any tax reform will “lose trillions” they are comparing their static estimates of revenues from those plans (which assume tax rates could double or be cut in half with no effect on growth or tax avoidance) to totally unrealistic “baseline” projections from the Congresional Budget Office.  Those CBO projections assume that rapid 2.4% annual increases in real hourly compensation over the next decade will push more people into higher tax brackets every year.  As a result, the average tax burden supposedly rises forever – from 17.7% of GDP in 2015 to 19.9% in 2045 and 23.8% by 2090.  And, typical of static estimates, this ever-increasing tax burden is imagined to have no bad effects on the economy.

Such a high level of federal taxation never happened in the past (20% was a record set in the tech stock boom of 2000) and it will never happen in the future.  In short, this is an entirely bogus basis by which to judge tax reform plans.

A far more sensible question would be this:

Will the Cruz or Rubio tax reforms raise just as much money as the Obama “tax increase” has – namely, 17.5% of GDP from 2013 to 2015. If so, then real tax revenues will grow faster after reform because real GDP growth will surely be at least 1.2% faster – or a middling 3.5% a year, which is all the cautious Tax Foundation estimates suggest.

Ted Cruz’s Defense Spending Plan: Lots of Debt, Not Much Strategy

Ted Cruz says the defense plan he unveiled Tuesday in South Carolina would give the U.S. military “more tooth, less tail.” Actually Cruz’s plan would produce more of everything, especially debt.

Cruz says that as President he’ll spend 4.1 percent of gross domestic product (GDP) on defense for two years, and 4 percent thereafter. As the chart below shows, under standard growth predictions, Cruz’s plan produces a massive increase in military spending: about $1.2 trillion over what would be Cruz’s first term and $2.6 trillion over eight years. Details on the chart are at the end of this post.

The chart also shows how much Cruz’s plan exceeds the Budget Control Act’s caps on defense spending, which remain in force through 2021. Spending bills exceeding those caps trigger sequestration: across-the-board cuts that keep spending at the cap. So Cruz’s plan depends on Congress repealing the law. Experience suggests that Congress will instead trade on dodgy future savings to raise caps by twenty or thirty billion a year—about a tenth of what Cruz needs.

Cruz is relatively clear on the tooth—force structure—he hopes to buy. He’d grow the Army’s end strength to 1.4 million, with at least 525,000 in the active force. Those numbers are scheduled to fall to 980,000 and 450,000 in 2018. Cruz would “reverse the cuts to the manpower of the Marines,” which presumably means going from the current 182,000 active to the 202,000 peak size reached in 2011 for the Iraq and Afghanistan wars. The Navy would grow from 287 to at least 350 ships, and the Air Force would add 1,000 aircraft to reach 6,000. The plan would also modernize each leg of the nuclear triad of intercontinental ballistic missiles, bombers and submarine-launched ballistic missiles. It asserts that the triad is “on the verge of slipping away,” ignoring current plans to modernize each leg, needlessly.

Congress Can Deny Barack Obama the Power to Replace Justice Scalia

Senate Majority Leader Mitch McConnell (R-KY) responded to the sudden death of Supreme Court Justice Antonin Scalia with a press release saying, “this vacancy should not be filled until we have a new President.” Republican presidential candidates Ben Carson, Sen. Ted Cruz (TX), and Sen. Marco Rubio (FL) agree. Hillary Clinton spoke for many Democrats: “The Republicans in the Senate and on the campaign trail who are calling for Justice Scalia’s seat to remain vacant dishonor the Constitution. The Senate has a constitutional responsibly here that it cannot abdicate for partisan political reasons.” Conor Friedersdorf says the no-vote stratagem is “illegitimate” because “the Senate does have an obligation to fulfill its ‘advice and consent’ obligation….A preemptive rejection of any possible Supreme Court appointment is self-evidently in conflict with that obligation.” Clinton and Friedersdorf are wrong. Senators have every right to advocate not holding a vote on an Obama appointment, and not to hold a vote.

Clinton and Friedersdorf are overlooking the “consent” part of “advice and consent.” Consent means the Senate is under no obligation whatsoever even to hold a vote on any presidential appointment. The Senate’s obligation is to do what the Senate wants, and only what the Senate wants. Those are the rules. To try to hold senators to a different rule is to try to change the rules on them–and people tend to resent that. Everyone is free to disagree with the positions individual senators or the Senate as a whole take on individual nominations or prospective nominations. But there is no question that senators individually or collectively can deny their consent to any actual or prospective nomination for any reason–just as the American people can vote for whomever they want, for whatever reason they want.

Indeed, President Obama isn’t even entitled to nominate a replacement for Justice Scalia–or at least, Congress can deny him that right. The Constitution gives Congress the power to decide how many seats there are on the Supreme Court. In 1789, there were only six. Given sufficient congressional support (i.e., veto-proof majorities in both chambers), Congress could reduce the number of Supreme Court justices from the current nine to eight. McConnell, Cruz, and Rubio could propose doing so right now. It seems strange to criticize senators who are merely expressing in what circumstances they will withhold their consent when Congress has the power to deny the president the ability to fill this vacancy entirely by itself eliminating this vacancy.

At the same time Democrats turn a blind eye to President Obama repeatedly ignoring constitutional limits on his power, they claim Republicans would dishonor the Constitution if they use powers the Constitution clearly grants them. That is unlikely to dissuade Senate Republicans from delaying a vote on Scalia’s successor until 2017. Nor should it. For more on this topic, please read this by my colleague Ilya Shapiro at Forbes.

Scalia’s untimely passing was a gut punch. I didn’t agree with him all the time. But I agree with Trevor Burrus about him. RIP.

Ted Cruz, PolitiFact, ObamaCare & Jobs

I have two posts up at Darwin’s Fool on ObamaCare’s impact on jobs. In one post, I critique Politifact’s ruling that GOP presidential candidate (and Iowa caucus winner) Sen. Ted Cruz (TX) is a liar for claiming that ObamaCare is a job-killer. An excerpt:

In their rush to label Ted Cruz a liar, PolitiFact ignored economic theory, ignored economic consensus, ignored problems with the evidence they had amassed, ignored that some of the evidence they collected supports Cruz, ignored reams of anecdotal evidence, and dismissed Congressional Budget Office projections based on nothing more than a subjective and arbitrary distinction PolitiFact themselves invented.

In the other post, I offer a compilation of media reports about employers who have eliminated jobs or switched to part-time hiring.