When Projections Attack

There are lies, damn lies, statistics and now, apparently, also Congressional Budget Office estimates. In January researchers at the C.B.O. released some new numbers about the expected long-term impact of the Affordable Care Act. To make their hard-to-parse estimates seem a little more real, the authors projected that by 2024, the health care act would lead to the loss of 2.5 million jobs as Americans left the U.S. labor force. That number proved irresistible to Obamacare haters, many of whom seized upon the report, even before reading it, in denunciations that scorched across Twitter feeds, conservative blog sites and the Bizarro World of cable news.

People who actually read the report quickly understood there was a little more nuance to the C.B.O.’s projection. Far from deathpanelling America’s employment stock, the A.C.A. would “reduce the total number of hours worked…almost entirely because workers will choose to supply less labor.”

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What does that mean? The C.B.O. report suggests that health care reform would have the long-term effect of allowing people to leave work if their only reason for remaining employed was to keep a connection to health insurance. So the projection did not imagine employers erasing jobs, but workers freed from the bonds of health care insurers and perhaps following their bliss for a change. The media narrative quickly adapted. Now the C.B.O. report was not detailing job destruction caused by health care reform, but a new Hydra head of the Obama entitlement monster, a “disincentive” to work created by relieving mass anxiety over health care.

This new narrative attached itself to the resilient depiction of the “Obama-nation of takers” pitted against the stalwart “makers,” those who are ruggedly individualizing out there in the U.S. economy, entrepreneuring like crazy and creating wealth that the Obama sheeple are madly redistributing. Now, because of the A.C.A., a whole new cohort of takers too lazy to hang on to jobs in which they felt trapped are being liberated by a new entitlement.

There is, of course, more than a whiff of scolding Calvinism in this new reading of the C.B.O. projections. What might a more charitable interpretation of the same look like? In the Catholic tradition in the United States, work is a meaningful and rewarding aspect of co-creation, but so are things like raising a family and sufficient time to enjoy the beauty and blessedness of creation. We are not our best possible selves merely yoked to a job  producing income and propping up the gross national product. Holding a child, visiting with neighbors, painting a landscape and, yes, even leaving a job we hate to raise a child, care for a sick family member or start our own businesses are also valuable expressions of a fully realized life. In other words, it should be hard for a Catholic to think less of a working senior who seizes on the option granted him by the A.C.A. to finally go ahead and retire or to admonish working parents who take advantage of the A.C.A. to be where they would rather be—at home raising their children.

How should health care be measured in a balancing of the common good? In a sharp contrast with the more communally minded members of the industrialized West, in the United States it has become nearly an article of faith that health care is a commodity on more or less equal footing with other consumer choices. Some believe the privilege of accessing it is reserved to the consumer wily enough to prepare to afford it. Of course, the Catholic tradition considers access to decent health care not a social privilege doled out to the astute and salaried, but a basic human right, a minimum guarantor of a just society, offered to all according to need.

In his second inaugural address, President Obama argued that “the commitments we make to each other—through Medicare, and Medicaid and Social Security—these things do not sap our initiative; they strengthen us.  They do not make us a nation of takers; they free us to take the risks that make this country great.” The new “entitlement,” access to decent, dependable health care, may soon be spoken of in the same way, as a modest step toward—not a nation of takers—but maybe a nation of brother’s keepers.

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Richard Salvucci
3 years 9 months ago
With all due respect, how does one ration a "right?" Do I have a "right" at the age of 95 to a procedure whose cost in resources could feed 10 Americans half my age for year? The soft demagoguery of the rhetoric of Catholic "tradition" offers no guidance to such prosaic questions. It merely preempts the moral high ground, and leaves the rest of us who worry about how to pay for things looking like heartless, secular bean-keepers who don't much care about our brothers. Well, tell you what. I care about my brother, because care requires a basis in making material decisions that affect the welfare of real people, and not merely empty attitudinizing.
Marie Rehbein
3 years 9 months ago
We should not lose sight of the fact that life is terminal. I know that I do not like going to doctors and no amount of health insurance will change that. Even if it were free, the idea of sitting in the waiting room, then being undressed and probed, then being given a prescription with probable side effects is enough to deter me from rushing to the doctor. However, because I have people dependent upon me, I do what I must to prevent conditions that could end my life prematurely. I wonder how people who do have expensive procedures reason out the choice to have them. Perhaps you have some insight?
Stanley Kopacz
3 years 9 months ago
I hope, when the time comes, I fall over like a tree. However, modern medicine presents us with all kinds of decisions in our final days. Should I allow expensive procedures that may only prolong life a few months? If I were under universal medicare, I think I would be more motivated to forego treatment as it would be taking resources that might give years to a sick younger person. However, covered, as I am, by a profit-taking company, I think I'd say, "$480,000? do it". Why should I care if I cut into the profits of a self-serving economic entity?
Kevin Clarke
3 years 9 months ago

You don't ration a right, you ration health care procedures. Before ACA as a society we rationed them based on the ability to pay for health insurance, not on what made the most sense for the person or for the common good. The questions you ask are preciely the ones that the Catholic tradition indeed does grapple with. I disagree that the tradition does not offer any help in making "prosaic" decisions.

Richard Salvucci
3 years 9 months ago
It's incoherent to blithely emphasize the inefficiency of the American medical system--huge expenditure, mediocre outcomes according to the OECD--and then pretend that medical care is anything other than a commodity. I'd like to see a single payer system. I'm not going to get one. I'd like to see Jesus return and do a loaves and fishes makeover with the medical system. He doesn't seem interested in getting involved. Our system is busted precisely because prices don't reveal scarcities and fee-for-service medicine distorts incentives. I don't like living in the real world either, but until we address those problems squarely, your "right" is the next generation's declining standard of living, but somehow economists are the problem for insisting that we stop kidding ourselves about the trade off. Maybe we wouldn't have 50 million people without access to care if we didn't spend--what must it be now?--8 percent of GDP on 5 percent of the population? You're ok with the kind of inequality, I presume?
Stacie Beck
3 years 9 months ago
ACA is economically destructive because of the way it is designed. Employer mandates and subsidy design discourage both the demand side and supply side of the job market. This is one reason the recovery, especially in jobs, is so slow. It is also designed to escalate, not reduce, the cost of medical care and lower its quality. Under ACA, care will eventually become rationed and less available, unless one has enough wealth to pay privately. Eventually it will also become financially unsustainable, like Social Security and Medicare. All this is already set in motion. It did not have to be this way. There were a number of health care proposals that would avoid/reduce the perverse incentives and achieve a greater coverage than the ACA has. The Democratic members of Congress were not interested in those. Kevin Clarke owes it to his readers to educate himself on the alternatives to ACA rather than labeling its opponents as 'some (who) believe the privilege of accessing it is reserved..'. Maybe he knows personally such monsters. But some are just economists who want to reach the same goal he does.
Marie Rehbein
3 years 9 months ago
Single payer was not politically viable, so the ACA is a start. You write, however, that this has had some impact of jobs recovery, and I think there is no connection whatsoever. You write that it is designed to escalate costs and lower quality, but you offer no substantiation. You also assert that Social Security and Medicare are financially unsustainable when that is simply untrue. Since you reference Democratic members of Congress, I would assume that you are simply making a political statement intended to incite animosity against both the party and the legislation, while discounting the importance of the ACA to those who have not been able to have health insurance before.
Kevin Clarke
3 years 9 months ago

Prof. Beck,

The CBO reports that over ten years ACA will save the government somewhere north of $140 billion. I find it hard to believe that the ACA, most employer provisions of which are not even implemented, can be counted among the major contributors to the nation's sluggish growth out of the Great Recession. I would blame sequestration and a lack a sufficient stimulus spending before I'd try to blame rhetorical winds from health care refrom.

In terms of rationing care, how exactly would you describe a system that leaves out about 50 million people? The status quo system was killing 20,000 to 45,000 people a year, according to the IOM and Harvard studies of Census data. That is true rationing.

The sustainability of SS and Medicare are political calls, not economic inevitabilities. I've heard in just two days Congress members blithely discuss liberating billions of dollars from the federal budget to buttress Ukraine against the Russian Federation. I agree health care reform did not have to be this way, but the health insurance lobby was too strong and an alternative that would have properly, rationally contained health care costs never was in the serious running. That's why the U.S. spends two to three times more than any OECD peer for a systemt that has consistently produced inferior care and outcomes for patients and billions in profits and salaries and bonuses for insurers.

I never called anyone monsters, but I am truly astonished to discover that an economist interested in free market-based approaches to responding to social needs, such as Prof. Beck, is unaware of a vast sentiment in American culture against treating health care as a human right. I suggest googling "health care is not a right" and reviewing what materializes. You will find thousands of examples of commentary from this perspective--everything from Red State raw meat tosses to more refined Randian rejections--with ease (http://www.aynrand.org/site/News2?id=13873). Here is one of example of a "moderate" position: http://www.forbes.com/sites/richardsalsman/2012/04/03/memo-to-the-supreme-court-health-care-is-not-a-right/

KC

Mike Van Vranken
3 years 9 months ago
Catholic tradition would encourage you and me to provide health care to everyone because we love them. Catholic tradition never teaches we should shirk that responsibility and turn it over to a civil government. You and I, through the Church, should provide health care to everyone. There is no other option. When the disciples recommended to Jesus that he dismiss the crowds so they could go into town and get something to eat, he said "you feed them." He never recommended they ask the Roman government to feed them. Sowing and Reaping. Give and it will be given unto you. Why don't we practice that?

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