Sunday, February 14, 2010

Again with the Doing Stuff

Nate Silver has a good post over at FiveThirtyEight that looks at slight boosts Democrats received after passing the House and Senate versions of Healthcare reform last year. Polling disclaimers aside, I think this goes to a point I was trying to make a couple weeks ago in the comments in a debate with Colin (here and here). It was my contention that Democrats will pay a political price in the autumn for Healthcare reform regardless of whether they pass a bill or not. I further argued that, on balance, getting something done was of greater political value than not getting anything done.

14 comments:

Colin said...

Well, I think Silver is absolutely correct -- passing health care reform will help to energize the base. But while energizing the base may be a necessary condition for triumphing at the ballot box, it is not sufficient. To win, you need not only the Dem base but also independents. Passing HCR will ensure independents stay in the GOP column.

If I'm Michael Steele I'll make that trade any day of the week.

If your contention is simply that Dems are going to get killed anyway, so why not pass the bill, I get that. But earlier I got the sense you were arguing that Americans were upset Dems weren't getting anything done, which I don't think is the case at all. Rather, the more Democrats do, the more upset people are. In fact, if you look at pollster.com it seems opposition to HCR started to flatline around mid-December, which is when the last Congressional action on the issue took place.

Ben said...

No, the point is that regardless of passage, the Republicans will hammer the Democrats as if they passed the bill. Further, after expending a year (or more) on attempting to pass a HCR bill, non-passage opens the Democrats up to, among others, a narrative that they are unable to govern. Finally, it's not merely that the Democrats in Congress received a bump among Democrats with the House and Senate passages, but that such a bump did not come at the expense of a loss of support among independents or Republicans. Thus, passing the bill does no harm to the Democrats ability to win the all important median voter.

Colin said...

Well, Silver's analysis may be correct that HCR won't cost Dems further with indies (although I have my doubts), but I'm not sure that is really cause for celebration. I mean, right now Dems should be focusing on winning support from indies, not merely contenting themselves with halting further erosion. After all, if the status quo persists until November the Democrats are going to be in for a long night come election day.

The median voter already seems to be tilting GOP. Passing HCR doesn't strike me as a means of wooing them back.

Colin said...

This is also worth considering:

http://realclearpolitics.blogs.time.com/2010/01/26/dems-puzzling-political-arguments-for-passing-hc/

Ben said...

Sean's argument is premised on the notion that people won't like lower healthcare premiums. Really, that's basically it. Look, HCR is just not like the assault weapons ban and the comparison is disingenuous. It is also not like the privatization of social security (the other analogy he draws). There is a political upside to passing it whereas the political downside (from Silver's analysis) is apparently locked-in. That is, Dems will pay the same cost regardless of its passage; passing it, however, may or may not pay dividends.

And, just for consistency's sake, I'll point out again that it's not HCR that I think people are opposed to, it's the process. Getting out from under the process as quickly as possible (that is, passing the bill) will also earn the Democrats rewards.

Colin said...

Sean's argument is premised on the notion that people won't like lower healthcare premiums.

Really? Where exactly does he say that?

And, just for consistency's sake, I'll point out again that it's not HCR that I think people are opposed to, it's the process.

Well, that's a theory, and a plausible one, but it's also not readily provable. What we do know is that voters didn't like HCR in 1993-94 and they don't like it now, even though the process differed on both occasions.

Ben said...

Sean's argument is premised on the notion that people won't like lower healthcare premiums.

Really? Where exactly does he say that?


It's implicit in his comparison to 1994:
Now I think a 1994 analogy is apt. In 1994, gun owners didn't suddenly realize that the Assault Weapons Ban would not result in Janet Reno taking away their hunting rifle.

Presumably, the analogy here is that, like the Assault Weapons Ban, which reduced access to assault weapons, people won't like health care which reduces access to . . . obscenely high premiums? I just don't buy that--I think people will like paying less for healthcare without diminished quality.

We also know that HCR was very popular before the process began. For example, in February 2009, a CNN/Opinion Research survey found that 72% of American's favored a "program that would increase the federal government's influence over the country's health care system in an attempt to lower costs and provide health care coverage to more Americans."

Colin said...

Presumably, the analogy here is that, like the Assault Weapons Ban, which reduced access to assault weapons, people won't like health care which reduces access to . . . obscenely high premiums? I just don't buy that--I think people will like paying less for healthcare without diminished quality.

You're confusing intentions with outcomes. I mean, as someone who pays for their own health insurance I'd love lowered premiums and undiminished quality (mine just went up last week). However, I have zero confidence that increased government intervention will deliver that, given its abysmal record with Medicare, MA's universal coverage, TennCare, etc.

We also know that HCR was very popular before the process began. For example, in February 2009, a CNN/Opinion Research survey found that 72% of American's favored a "program that would increase the federal government's influence over the country's health care system in an attempt to lower costs and provide health care coverage to more Americans."

I have a couple of thoughts on this poll. First, I don't like the wording, which seems to have a linkage between more government and improved performance. Seems to me a better question would be a long the lines of: "There is much talk in Washington of reforming health care. Do you think the health care system should be reformed through expanded government intervention, reformed through less rules and regulations and more market-based solutions, or left largely as is?"

I'd put a lot more stock in that answer.

Second, even if we accept that people actually do favor more government, it seems this is only the case until the rubber actually meets the road. Expanded government sounds great until that expansion means you can't keep your current plan, or you are forced to buy insurance you don't want, or your taxes are increased, etc. Until that point it is simply abstract and people imagine it involves zero pain and lots of goodies like lowered premiums.

Colin said...

Oh, and here's a recent poll which asks people not about specific legislation, but the role of government regarding health care:

http://www.gallup.com/poll/124253/say-health-coverage-not-gov-responsibility.aspx

Ben said...

I am not confusing outcomes with intentions and, what's more, government health care reform in Massachusetts has not been "abysmal." In fact, not only does Massachusetts suffer the lowest rate of uninsured persons in the country, since 2006 (the year of reform), non-group health care premiums have dropped from $8,537 per year to $5,143 -- that's a 39.8% reduction.

And your recent poll does nothing to refute my continuing claim that HCR is popular, the process isn't. It's just yet another data point demonstrating that people have been soured by the process.

Colin said...

I am not confusing outcomes with intentions.

Yes, you are. You are assuming that because lowered premiums are the goal, that is what will happen. There is no way for us to know that. If stated objectives and outcomes we're the same, we'd have won the wars on poverty and drugs, would have first-class schools, etc.

and, what's more, government health care reform in Massachusetts has not been "abysmal." In fact, not only does Massachusetts suffer the lowest rate of uninsured persons in the country, since 2006 (the year of reform), non-group health care premiums have dropped from $8,537 per year to $5,143 -- that's a 39.8% reduction.

Well, it's a success if expanded insurance coverage is your metric. But insurance is just a means to an end -- health care (and a pretty poor one at that). Better measurements are health outcomes and cost control, neither of which is apparent in MA.

In fact, overall health spending in MA continues to race ahead:

http://www.nytimes.com/2009/03/16/health/policy/16mass.html?pagewanted=print

If you are paying less in premiums but your taxes are going up to fund the state subsidy, is that really a win? Is it a win if you are buying insurance you would rather not?

Meanwhile, company health insurance rates are surging:

http://www.boston.com/yourtown/wellesley/articles/2009/11/15/blue_cross_rates_for_small_businesses_to_surge/

Note this part:

“The main driver in insurance premiums is the cost of health care,’’ Maltz said. Another factor, he said, is the state universal health care law, which has compelled insurers to merge newly insured individuals - a high-cost group - into small-business insurance plans.

In fact, the situation is so out of hand that Deval Patrick is now taking the rather Nixonian approach of seeking the power to simply ban premium increases if they are deemed excessive:

http://www.boston.com/news/health/articles/2010/02/11/patrick_wants_health_cost_veto/

Let's also remember that MA announced plans last summer to drop 30,000 legal immigrants from coverage in order to help contain costs:

http://www.nytimes.com/2009/07/15/us/15insure.html

This is also worth noting from the WSJ editorial board:

http://online.wsj.com/article/SB10001424052748704107204574471452635287352.html

So now Beacon Hill is contemplating far more drastic spending-control measures, such as a plan to "require residents to give up their nearly unlimited freedom to go to any hospital and specialist they want," as the Boston Globe reported on Sunday. Paul Levy, the CEO of Beth Israel Deaconess Medical Center, told the Globe that "You can't reap these savings without limiting patients' choices in some way."

I'd also recommend reading this:

http://www.nytimes.com/2009/07/16/us/16hospital.html?ref=todayspaper

Is this what success looks like?

And your recent poll does nothing to refute my continuing claim that HCR is popular, the process isn't. It's just yet another data point demonstrating that people have been soured by the process.

I don't know how this can be refuted, as any poll in which the public looks askance at expanded government intervention is dismissed as a result of process.

Ben said...

First, the point of health care reform is to cover more individuals. Second, not a single source you point to indicates that health care quality has been reduced in Massachusetts--your only substantive criticism of my point. So, again, I'm not confusing outcomes with intentions, and you're not able to demonstrate that expanded coverage has reduced quality. As far as business cost being increased, I demure--what do you expect when they're forced to, you know, cover their employees?

Colin said...

First, the point of health care reform is to cover more individuals.

That may be one goal, although I am not sure why such a high priority is being placed on it. Insurance and access to health care aren't the same thing.

The far more important part of HCR is to reduce costs -- bend the cost curve downward as the Obama Administration famously promised. This is clearly not taking place in MA.

Second, not a single source you point to indicates that health care quality has been reduced in Massachusetts--your only substantive criticism of my point.

Perhaps not yet -- it's only been a few years -- but already measures are being contemplated to reduce patient choice. And as with anything (schools for example), once you take away choice quality begins to suffer.

So, again, I'm not confusing outcomes with intentions, and you're not able to demonstrate that expanded coverage has reduced quality.

Unless you can get in a time machine, go to the future, see the results, and then come back and report, you are stating intentions, not outcomes. You may think that reform will reduce premiums -- and maybe it will -- but you simply can't definitively state this will occur.

As far as business cost being increased, I demure--what do you expect when they're forced to, you know, cover their employees?

Well, when they are forced to do so (which is insane -- why is employment linked to health insurance?) and their costs increase, don't be surprised when businesses are reluctant to hire more workers. And again, weren't reduced costs and not increased premiums supposed to be one of the virtues of HCR?

In MA we see spiraling health care costs, surging group coverage rates and measures to reduce coverage (legal immigrants who pay taxes but don't vote). Reduced choice is on the way.

This is success?

Colin said...

Also, Timothy Noah (who as a veteran of the Washington Monthly is not exactly a member of the vast right wing conspiracy) notes in his Slate column today:

http://www.slate.com/toolbar.aspx?action=print&id=2245236

CBO's main findings were that by 2016 the Senate health reform bill would have virtually no impact on large-group premiums and would raise nongroup premiums 10 percent to 13 percent.