Monday, November 8, 2010

Was health-care reform worth the Democrats' losing the 2010 elections?

William Saletan says yes:

Politicians have tried and failed for decades to enact universal health care. This time, they succeeded. In 2008, Democrats won the presidency and both houses of Congress, and by the thinnest of margins, they rammed a bill through. They weren't going to get another opportunity for a very long time. It cost them their majority, and it was worth it.

And that's not counting financial regulation, economic stimulus, college lending reform, and all the other bills that became law under Pelosi. So spare me the tears and gloating about her so-called failure.
I'm not convinced. First of all, to say that X is "worth" Y implies that Y somehow allowed you to obtain X. It's not clear that losing at the polls last week allowed Democrats to support health-care reform. As this NYT article that Saletan himself links to says:
[E]ven the Democrats who bucked the White House and their party’s leadership by voting against the measure gained little protection. Of the 30 Democrats who opposed the final bill and then stood for re-election, 17 lost anyway.

Indeed, among 49 Democratic incumbents who lost on Tuesday, 32 had voted for the health care law and 17 against it. . . .

Surveys of voters leaving the polls found deep division over the health law. Nearly half of voters — 48 percent — said they thought it should be repealed, while 31 percent said Congress should expand it and 16 percent said it should be left as is.

“When pollsters asked, voters listed health reform among the top issues on their mind, which is no surprise after a long, heated debate,” said Drew E. Altman, president of the Henry J. Kaiser Family Foundation, which conducts health policy research. “But there is little evidence that it was decisive in the vote.”
And if health-care reform was such a huge factor in the Democrats' losses, wouldn't you expect the one member of Congress who was most closely associated with it — Nancy Pelosi — to have performed worse in 2010 than in 2008? But just the opposite happened.

Saletan also ignores state legislatures, which, of course, had nothing to do with enacting the federal health-care law. Democrats in state legislatures still massively lost at the polls.

I also don't accept Saletan's substantive point — that the health-care law was such a great accomplishment that Democrats should feel fine about losing control of the House and getting closer to 50 than 60 Senators. Saletan flatly states that the Democrats enacted "universal health care." If I believed that, I'd agree with him: this would be good and important enough to be worth losing an election.

But I'm simply not convinced that the actual law (as opposed to Saletan's glowing description of it) is good enough to be worth enacting at all, let alone suffering a huge political loss for enacting. This New Yorker article is the best thing I've read about the health-care law. In a nutshell, the article says:
1. The cost and revenue projections rely on unrealistic assumptions and accounting tricks. If you make some adjustments for these, the cost of the plan is much higher.

2. The so-called “individual mandate” isn’t really a mandate at all. Under the new system, many young and healthy people will still have a strong incentive to go uninsured.

3. Once the reforms are up and running, some employers will have a big incentive to end their group coverage plans and dump their employees onto the taxpayer-subsidized individual plans, greatly adding to their cost.
I'm tempted to copy and paste the whole article here, but I'll just give his argument on point #2:
Consider the so-called “individual mandate.” As a strict matter of law, all non-elderly Americans who earn more than the poverty line will be obliged to obtain some form of health coverage. If they don’t, in 2016 and beyond, they could face a fine of about $700 or 2.5 per cent of their income—whichever is the most. Two issues immediately arise.

Even if the fines are vigorously enforced, many people may choose to pay them and stay uninsured. Consider a healthy single man of thirty-five who earns $35,000 a year. Under the new system, he would have a choice of enrolling in a subsidized plan at an annual cost of $2,700 or paying a fine of $875. It may well make sense for him to pay the fine, take his chances, and report to the local emergency room if he gets really sick. (E.R.s will still be legally obliged to treat all comers.) If this sort of thing happens often, as well it could, the new insurance exchanges will be deprived of exactly the sort of healthy young people they need in order to bring down prices. (Healthy people improve the risk pool.)

If the rules aren’t properly enforced, the problem will be even worse. And that is precisely what is likely to happen. The I.R.S. will have the administrative responsibility of imposing penalties on people who can’t demonstrate that they have coverage, but it won’t have the legal authority to force people to pay the fines. “What happens if you don’t buy insurance and you don’t pay the penalty?” Ezra Klein, the Washington Post’s industrious and well-informed blogger, asks. “Well, not much. The law specifically says that no criminal action or liens can be imposed on people who don’t pay the fine.”

So, the individual mandate is a bit of a sham. Generous subsidies will be available for sick people and families with children who really need medical care to buy individual coverage, but healthy single people between the ages of twenty-six and forty, say, will still have a financial incentive to remain outside the system until they get ill, at which point they can sign up for coverage. Consequently, the number of uninsured won’t fall as much as expected, and neither will prices. Without a proper individual mandate, the idea of universality goes out the window, and so does much of the economic reasoning behind the bill.


Meade said...

A bit of a sham here, a bit of a sham there, and pretty soon we're talking about one big hoax.

Meade said...

Has there ever been a Supreme Court decision authorizing Congress to force private citizens to buy products they did not want?

It seems to me not implausible that a large number of healthy voters between the ages of twenty-six and forty - a demographic that historically shifts from liberalism toward more conservative values as it ages - could be permanently lost to the Democratic Party because of the trickery and sham of the so-called health-care reform law.

John Althouse Cohen said...

Has there ever been a Supreme Court decision authorizing Congress to force private citizens to buy products they did not want?

To say that the issue is about regulating the products people buy actually suggests that Congress did have the constitutional authority to enact health-care reform under the Commerce Clause.

The Supreme Court in Lochner v. N.Y. viewed the Constitution as strongly protecting economic liberty. That was in 1905. The Court abandoned that approach in the '30s and has never gone back to it.

Now, Lochner wasn't about whether the Commerce Clause authorized the U.S. Congress to pass a law; it was about whether a state law violated due process. (State laws, unlike federal laws, don't need to be authorized by the Commerce Clause.) But there's a broader point to the demise of Lochner.

As the historic and brilliant dissents to Lochner by Justices Holmes and Harlan explained, matters of federal economic policy should generally be left to Congress (a body of officials who have been elected to deal with such matters), not by (unelected) Supreme Court justices purporting to follow the Constitution. If the health-care law is such an objectionable infringement on private citizens' liberty, the people can elect legislators who will repeal it. Legislators and justices are all flawed human beings who may have ulterior motives, but someone has to make the judgment call, and the legislators are in a better position to make that judgment than the justices.

Unknown said...

I care less on which party wins and which party will populate the Congress. It may add to the tension but I would rather ask them to think of developed reforms rather than bragging what they or their party have enacted. I'm a patient who undergoes chiropractic. Woodland Hills , from where I live is blessed to have doctors and hospitals in West Hills. Chiropractic experts have been very necessary for old age for it serves as a diagnosis to prevent mechanical disorders.