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Tuesday, November 19, 2013

On health policy analysis and jerks

I recognize that, in clicking on this headline, I was acting in accordance with a click-bait strategy: "Obamacare Shows How Americans Are Becoming Jerks." The Bloomberg company is under some financial stress at present so more such desperate-for-traffic headlines are likely to appear. Still, the piece, by Bloomberg editorial board member Christopher Flavelle, really is encapsulated by that headline. Here are the first two paragraphs:
New Gallup poll numbers show Americans increasingly dispute the idea that government has a responsibility to make sure everybody can get health insurance. It's tempting to see that as an indictment against Obamacare, but it might just mean more Americans are becoming jerks. 
What's clear is that the shifting views on health care predate the Affordable Care Act. The number of Americans who think health care is the government's responsibility hovered around two-thirds for the first half of the 2000s, peaking at 69 percent in 2006. Then those numbers started falling, hitting 50 percent in 2010 and 42 percent this year.
Me: Note the disingenuousness in the above (which persists throughout the piece). Flavelle refers repeatedly to "government" and "the government" without modifying that to say "federal" or "U.S." government. But when you look at the Gallup poll he cites, the question's wording was "Do you think it is the responsibility of the federal government to make sure all Americans have health coverage, or that it is not the responsibility of the federal government?" Federal--it's there twice on one sentence. So, if someone thinks it's a responsibility of state government, they would fall under Flavelle's "jerks" category. Of course, there are many other ways to get into Flavelle's "jerks" category, such as thinking that it's highly desirable for people to have health insurance and thus that government (federal or state) should not enact policies that actually make it harder to get health insurance or that get you kicked off your current plan.

I am, as those who have previously visited this blog can attest, a Republican who has been critical of his own party a great deal in recent years. I strongly disagreed with the strategy, if you can call it that, of using the debt ceiling and government shutdown as tools for derailing Obamacare, and it certainly wasn't because I liked Obamacare; I think Obamacare was badly conceived as well as badly implemented. I also note that, even now, most of the public does not want a full repeal of the program; bear in mind that the status quo ante was not very good, and that it can't readily be returned to now that the insurers have revamped their systems and product lines to comply with the clunking contraption.

In other words, I think the insurance market is a complicated mess that the Obama administration has now made significantly worse. Seeing what has happened increases my pre-existing skepticism that the federal government should be tasked with ensuring that everyone has health insurance. So I would've been with the majority in that Gallup poll. Does this mean I want "government" at any and all levels to do nothing? No. I can imagine the states doing various things to experiment with improved healthcare delivery, and I can also imagine the federal government helping by, among other things, enabling some experiments with interstate commerce in insurance policies. I can imagine government, at various levels, making it easier--not harder as Obamacare did--for people to have more control over their health decisions through tools such as health savings and flexible spending accounts.

If that makes me a jerk, so be it. But congratulations, Flavelle, on getting some traffic.

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