No ‘A’ for Effort

Obamacare’s fiascos can’t be excused on the grounds that the president meant well.
November 20, 2013 • Commentary
This article appeared on National Review (Online) on November 20, 2013.

Writing for Salon, Brian Beutler speculated that if President Obama was lying about whether people could keep their current insurance plans under Obamacare, it was a “noble lie.” Several other commentators have made similar observations. Obamacare may be a mess; it may be built on a framework of legal, political, and economic distortions; and it may have been pushed through by playing the hardest of political hardball. But the president’s heart was in the right place.

So many defenses of big government in the face of repeated failure seem to boil down this: Don’t judge us by results, judge us by our good intentions.

In this case, there clearly was a problem before Obamacare. Health care in America cost more than in any other country, and that cost did not always correlate with results. At the same time, too many Americans lacked health insurance, making it difficult for them to get the care they needed.

The president’s inclination was to ignore possible market‐​based fixes and turn to a government solution — despite the fact that many of the problems in the health‐​care system could be traced to earlier government interventions, and despite the government’s long track record of failure in addressing other social and economic problems. That he was trying to do something was good enough.

The president continues to make this case, arguing that he won’t reconsider the health‐​care law because “I’m not going to walk away from 40 million people who have the chance to get health insurance for the first time.” Yet even by this standard, Obamacare fails. According to the Congressional Budget Office, by 2023, long after the Affordable Care Act is fully implemented (and the website is presumably working), 31 million Americans will remain uninsured.

Sometimes good intentions are not enough.

Of course, Obamacare is hardly the only government program that’s failed to live up to its good intentions. Take government’s efforts to lift Americans out of poverty. No one can deny that trying to reduce poverty and help those in need is a worthy goal. But the federal government spends $680 billion per year on 126 anti‐​poverty programs. State and local governments spend an additional $280 billion. That’s close to $1 trillion. In fact, since Lyndon Johnson declared the War on Poverty half a century ago, we’ve spent more than $15 trillion on the effort, but poverty rates have barely budged.

Looking at specific programs, consider food stamps, officially known as the Supplemental Nutrition Assistance Program (SNAP). Any effort to cut spending on food stamps inevitably brings charges of heartlessness. Yet the Government Accountability Office found that “the literature is inconclusive regarding whether SNAP alleviates hunger and malnutrition for low‐​income households.” Similarly, a study for the Department of Agriculture found that for nearly all vitamins, minerals, and macronutrients assessed, the dietary intake among SNAP participants was comparable to that of non‐​participants.

Well, then, let’s try to help poor people get better jobs. Unfortunately, government job‐​training programs have an almost unblemished record of failure, with some programs actually leaving participants less prepared for future jobs than those who never enrolled. Overall, the GAO concludes that “little is known about the effectiveness of most programs.” No doubt that’s in part because “only five programs have had an impact study completed since 2004.”

And who could oppose a program to help low‐​income Americans receive health care? Indeed, there has been a barrage of criticism in the media of governors who have refused to go along with Obamacare’s expansion of Medicaid. John Kasich of Ohio, who bucked his fellow Republican governors by pushing through a Medicaid expansion, framed the issue as his Christian duty to help the poor, saying “my personal faith in the lessons I learned from the Good Book, run my life. . . . I can’t look at the disabled, I can’t look at the poor, I can’t look at the mentally ill, I can’t look at the addicted and think we ought to ignore them.” Yet, the first randomized, controlled study of the program’s effectiveness, the Oregon Health Insurance Exchange Study, found that “Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years.”

Head Start, another favorite of liberals and the media, is likewise another example of the failure of good intentions. According to a study by the Department of Health and Human Services, “by the end of 3rd grade there were very few impacts found for either cohort in any of the four domains of cognitive, social‐​emotional, health and parenting practices.” No matter, President Obama wants to spend another $75 billion on early‐​childhood education.

In fact, the evidence suggests that many of government’s efforts to fight poverty may not just fail, but actually be counterproductive. To the degree that welfare programs increase the rate of out‐​of‐​wedlock births and family disintegration, or discourage entry into the labor force, for example, they can trap people deeper in poverty for longer. At the same time, government anti‐​poverty programs tend to crowd out private charitable efforts that may be more effective.

The perennial debate over raising the minimum wage is another example of good intentions trumping actual results. The idea that a person working hard for 40 hours a week should earn enough to live on is one that the vast majority of Americans immediately respond to. But the actual result of raising the minimum wage is primarily to eliminate jobs available to unskilled workers, the very people the policy is supposed to help. A comprehensive review of more than 100 studies on the minimum wage by David Neumark and William Wascher for the National Bureau of Economic Research found that 85 percent of the studies they reviewed found that increasing the minimum wage had a negative effect on employment. This should be no surprise: The U.S. Department of Labor concluded that the first minimum wage, set at 25 cents an hour in 1938, resulted in the loss of 30,000 to 50,000 jobs, or 10 to 13 percent of the 300,000 workers affected by the increase.

It is often said that the definition of insanity is “doing the same thing over and over again and expecting different results.” To which many of today’s politicians would seem to respond, “But at least it’s doing something.”

But “doing something” is foolish if that something doesn’t work. It is time to recognize that asking whether liberal solutions actually work is not hard‐​hearted or callous. To suggest that a government‐​run health‐​care program will not provide better health care is not the same as telling the poor to “die quickly.” To argue against throwing still more money at yet another anti‐​poverty program is not evidence of a “war on the poor.”

It is said that the road to hell is paved with good intentions. Big Government apparently uses the same road crew.

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