When Generous People Stop Kidding Themselves

Over at Tapped, Ezra Klein is wrestling with my interpretation of the new estimates of poverty and health insurance coverage released yesterday by the Census Bureau. I observed that after the 1996 welfare reforms made federal cash assistance less "generous," poverty went down. In contrast, federal health care spending grew ever more "generous," and the number of uninsured went up. I humbly submitted that perhaps Congress should stop being so "generous" with health care.

Klein thinks that's "crazy," but he misfires on poverty rates:

1. He suggests that economic growth of the late 1990s and the expansion of the Earned Income Tax Credit were responsible for the post-1996 reductions in poverty. (The EITC does not directly affect the poverty rate, but it does affect the decision to earn other income that does.) Certainly each played a part. But prior economic booms did not have as dramatic an effect on the poverty rate even when the EITC was present, and scholars like June O'Neill have estimated that welfare reform had larger effects than did the economy. Moreover, although the EITC encourages some people to work more, it reduces work overall by encouraging others -- those in the phase-out range -- to work less. That might lift some out of poverty, but it traps them and others on the lower rungs of the economic ladder.

2. He notes that poverty has increased every year from 2000 to 2004. True, but he is being selective in order to avoid the larger point that poverty remains lower now than at any point in the 17 years leading up to welfare reform. (Also, FWIW, poverty dropped slightly in 2005.)
3. He confuses the poverty rate for families (9.9 in 2005) with the overall poverty rate (12.6 percent in 2005).
4. Finally, he notes that the family poverty rate was lower in 2005 than in 1996. Yet he somehow believes this to be evidence that federal cash assistance does not contribute to poverty.

The political Left has had a really hard time dealing with welfare reform. When Congress pared back cash assistance, the Left assumed that bad things would happen (increased poverty, starvation, etc.). Instead, good things happened. But that evidence doesn't fit in the Left's model. They just don't know where to put it.

Klein is as confused about the health care side of the comparison.

1. Klein writes: "I don't know any health care wonks who think medical cost inflation is a product of government spending..." He should get out more. He should start by hanging out with Maryland's Mark Duggan and Yale's Fiona Scott Morton, who estimate that prescription drugs are 13 percent more expensive in the private sector thanks to Medicaid. He should read up on crowd-out of private health insurance, which isn't likely to make private insurance markets any more robust. Many people think that cost-shifting from Medicaid increases the cost of private coverage. Personally, I'd call that crowd-out of another sort, but the effect is the same. Klein should read about how MIT's Amy Finkelstein speculates that Medicare led to increased medical expenditures in the private sector as well. All of which affects insurance premiums.
2. Klein dismisses the idea of reforming Medicaid as Congress reformed welfare -- by cutting back assistance. But that's exactly what Congress did when it cut off Medicaid for non-citizen immigrants in 1996. Do I need to tell you what the Left predicted? Do I need to tell you what actually happened? Klein should add to his reading list Harvard's George Borjas, who found that coverage levels for non-citizen immigrants increased after they were cut from the Medicaid rolls -- a result that, Borjas argues, cannot be explained by the robust economy.
3. Finally, Klein writes that yours truly "[doesn't] want Big Government to start pummeling the medical-industrial complex." But as I argue elsewhere, so long as the government controls the money, the medical-industrial complex will never get the beating it deserves because producers will always have a disproportionate influence over political decisions that effect their incomes. We will not discipline the medical-industrial complex until we have patients on the side of restraining spending, and that will not happen until patients own the money that's being spent. Libertarians would love to pummel the medical-industrial complex. It would be (marginally) easier to do so were Klein to get out of the way.

Klein's post reminds me of the passage Charles Murray used to close his seminal work Losing Ground:

Most of us want to help. It makes us feel bad to think of neglected children and rat-infested slums, and we are happy to pay for the thought that people who are good at taking care of such things are out there. If the numbers of neglected children and the numbers of rats seem to be going up instead of down, it is understandable that we choose to focus on how much we put into the effort instead of what comes out. The tax checks we write buy us, for relatively little money and no effort at all, a quieted conscience. The more we pay, the more certain we can be that we have done our part, and it is essential that we feel that way regardless of what we accomplish...

To this extent, the barrier to radical reform of social policy is not the pain it would cause the intended beneficiaries of the present system, but the pain it would cause the donors. The real contest about the direction of social policy is not between people who want to cut budgets and people who want to help. When reforms finally do occur, they will happen not because stingy people have won, but because generous people have stopped kidding themselves.