Political Math

Archive for the ‘health care reform’ Category

In my last post, I offered an infographic positing that the recent health care reform bill was one of the most partisan pieces of major social legislation we’ve ever seen, comparing it to votes for civil rights (1964), medicare/medicaid (1965), and welfare reform (1996). The infographic was actually originally designed not to indicate partisanship per se, but to rebut the very specific complaint popular among many progressives that Republicans have always opposed major social legislation at the beginning and then come to accept it later on. They then claim that health care reform is no different than those other legislative acts.

As for that latter charge, which was the driving force behind the creation of the infographic, there’s no way around it: looking at the data and maintaining that Republicans have a history of reflexive unthinking opposition to social legislation is simply a denial of reality. Some more thoughtful individuals have tried to maintain the heart of that argument by asserting that ideology was previously spread across party lines in such a way that the ideological equivalent of Republicans in the 1960′s (and, I presume, the 1990s) were opposed to social legislation in a very partisan way.

It is true, my infographic is simplistic and that kind of a story could be lurking in the data. It was designed to debunk the original claim (mission accomplished) and to suggest that, in a “by the numbers” approach, the health care reform bill was not exactly a bipartisan triumph.

The funniest thing to me is that there is absolutely no way to argue that this vote was bipartisan in the strict sense. Disect the word itself. Bi – Two. Partisan – relating to parties (usually political). In order for the bill to be bipartisan, two parties had to vote for it. There was only one party that voted for this bill. It is de facto not bipartisan.

But most of the people who were arguing with me didn’t mean “bipartisan” in a literal sense, they mean it in a “Democrats tried to work with Republicans, but Republicans are jerks who hate President Obama so much that they wouldn’t vote for health care reform no matter what” sort of way.

The way I see it, Republicans who voted against the bill could have had three major reasons for doing so:

1. They’re jerks who want President Obama to fail (the “Party of No” theory)
2. They have principled reasons for opposing the legislation (deficits, scope of the federal government, constitutional concerns, etc)
3. They watched the polls and decided it wasn’t in their best interest

Now, it’s possible that the Party of No theory is correct and that all Republicans simply hate President Obama in an irrational way. However, in order to believe it whole heartedly, one would have to come to come to the conclusion that Republican congressmen are willing to lose their seats for the chance to stick out their tongues at President Obama. Assuming the villainy of one’s political opponents is a game for the young and angry; I’ve no taste for it. And anyone who thinks that politicians are constantly in a “f*** you, even if I lose my seat” mode hasn’t been following politics for very long. Congressmen like their jobs. Even the Republican ones.

In order for the Party of No theory to hold together, its adherents would also need to conclude that there are dozens of Democrats out there who also hate President Obama. While this is also a possibility, I’m starting to say “this is a possibility” in the sense that it is technically possible rather than in any way realistic. It seems far more likely that a number of Democrats were also watching the polls and decided that voting against this bill was in their best electoral interest.

Finally, much noise was made in 2008 by those in favor of a progressive Congress that we just voted in the most progressive congress of the last 30 years. With that in mind, let’s look carefully at the situation: The most progressive (liberal) Congress in the last 30 years passes a piece of legislation by a tiny margin without a single vote from the minority party and with dozens of Democrats voting against it and we are meant to believe that it was as bipartisan as it could have possibly been.

This kind of logic was laughable when Republicans tried it 6 years ago. It was perhaps optimistic of me to assume that Democrats and liberals would rise above such nonsense.

After I posted my last video on wait times for getting a doctor’s appointment in Atlanta, Georgia vs. wait times in Boston, Massachusetts despite the fact that insurance premiums are drastically more expensive in Boston, I received a more mixed response than to any of my other videos.

Fortunately, I have commenters who are much smarter than I am. So I want to take the time to make note of what was wrong with that video.

Things that were wrong:

• While I didn’t say this, I left the impression that the universal health coverage program in Mass was solely responsible for the expensive premiums. That is not the case. In the study I referenced, premiums were extremely high in Mass, but that was done before universal health coverage (UHC) was implemented. There has not (to my knowledge) been a similarly comprehensive study done since the implementation of UHC, so I cannot say that UHC inevitably leads to higher premiums.
• Instead of comparing Boston to all the places that don’t have UHC, I picked one place that I liked (I used to live in Atlanta). Atlanta is particularly good on wait times, but it isn’t average. It would have been far better to compare Boston to the rest of the country as a whole.

Things that weren’t wrong, but that people complained about anyway:

• “The cost of living is higher in Boston. That is what drives the insurance premiums higher”

  This statement was done by people who haven’t actually run the numbers. No one has yet explained to me how a 14% increase in cost of living between Atlanta and Boston explains a 300% increase in health insurance premiums. More importantly, no one has pointed out that doctors in Boston make significantly more than doctors in Atlanta (which would be a far more important data point for investigation).

  Also, it doesn’t explain the difference between Boston and Los Angeles. The Los Angeles cost of living is 22% higher than Boston, but they still have cheaper insurance. And they still have wait times that are half of Boston’s.

To me, the most important point of all of this is the fact that we may not have enough data to say that UHC has actually caused Boston to get a lot worse than it already was, but we do have enough data to say that it certainly hasn’t made things better.

Some people would point out such statistics as “Well, nearly everyone in Massachusetts has health insurance now! It’s been a success!” (In fact, that’s exactly what Mitt Romney does when he says we should, like, totally copy the Massachusetts model.)

But this isn’t a single variable issue, it’s a trade-off issue. If we gave everyone in the country health insurance, but it cost $1 trillion per year, everyone would be against it because the benefit outweighs the cost. Similarly, if we provided everyone with health insurance and kept the cost the same as before, but it took five times as long to get a treatment, most people would still be against it.

It is not self-evident to me that 100% health insurance coverage is a good thing because it depends so heavily on the trade-offs. You could have “100% health insurance coverage” as a matter of statistics, but if that means that it takes three years on a waiting list to get a hip replacement, I’ll stick with the 85% we have today.

And I’ve only mentioned three variables here (cost, insurance coverage and wait times). There is a balance between hundreds of variables that has to be maintained. If you ever listen to the President’s speeches on this issue, you come away with the impression that there will be no trade offs and that it will be cheap premiums, universal coverage and no wait times! And the government will make drugs cheaper.

Also, there will be rainbows and ponies.

Call me a cynic, but that kind of thinking about in the UHC plan strikes me as somewhat naive.

What I would like to see is a comprehensive study of the effects on the Massachusetts plan on the health care system. I don’t know that there are really that many positive effects other than “Look, everyone has health insurance!”

[youtube=http://www.youtube.com/watch?v=AqD-nMpsYAY&hl=en&fs=1&]

The next couple weeks are insane for me, but I’ve been sitting on this idea for some time and I figure its time to let it loose into the wild, spelling errors and all.

First, my sources.

• Wait time data – Merrit Hawkins and Associates 2009 Survey of Physician Appointment Wait Times
• Cost of Insurance Premiums – AHIP Center for Policy and Research Individual Health Insurance 2006-2007: A Comprehensive Survey of Premiums, Availability, and Benefits

Now for the caveats.

Wait times data are for routine checkups and does not count emergency care or diagnostic testing.

Phyllis Shlafly repeated the line that “The average wait is… the second trimester of pregnancy to see an obstetrician-gynecologist.” It looks like she is using the same documents that I’m using and if that is the case, that statements is absolutely false.

First of all, these wait times apply only to routine checkups (as stated above) and the OB/GYN checkups are “well woman” check-ups. Someone correct me if I’m wrong, but I don’t think that a pregnant woman falls into that category.

Second, the average wait time in that category is 70 days, which is really only the second trimester if you count the “Wait a second, I’m pregnant!” realiziation time, which might be OK if she mentioned that to he readers.

Now for the insurance cost data. This was a statistic I struggled with for quite some time. The reason is because the latest comprehensive data available was collected at the end of 2006 and beginning of 2007. This was so soon after the passage of the Massachusetts health care reform that it is very unlikely that it accurately reflects the results of that reform (which is something the study authors freely admit).

However, I’ve search high and low and cannot find any indication that the premiums have decreased at all. To the best of my knowledge, they have increased faster than the country average.

If this is true,  then the average individual health insurance premium in Massachusetts is somewhere around $830 per month.

But I figured I might as well underestimate in order to flush out people who might complain, so I used the non-specific and drastically reduced number of $600+ per month.

Finally, the most important question:

How close to the Massachusetts health reform is the Obama health reform plan?

Because, honestly, if they weren’t anything like each other, there would be no point in comparing them, would there?

The sad fact of the matter is that the Massachusetts model provides the closest real life approximation to the Obama plan that there is available.

They both have a government agency for providing health care exchanges. They both require business over a certain size to provide insurance for their employees or face penalties. They both require individuals to purchase insurance or face tax penalties.

Like it or not, I think we can look to Massachusetts as a miniature crystal ball to provide a glimpse into the future of health care in the US if the Obama health care plan is passed.