By Lambert Strether of .
I know, I know. Film at 11! But let us sorrowfully pull on our waders and look at . From the lead paragraph:
The current state of public opinion on health reform is really peculiar. If you’ve been following the issue at all closely, you know that the Affordable Care Act [ACA; ObamaCare] is one of the great comeback stories of public policy: after a terrible start, it has dramatically exceeded expectations. But hardly anyone seems to know that.
Let’s parse this out. Tellingly, Krugman conflates a public relations narrative (“comeback story”) with actual public policy success, and by what metric? ObamaCare “dramatically” (narrative again) “exceeded expectations.” What expectations? Whose expectations? Krugman does not yet say. Be that as it may, if “you’ve been following” electoral tactics “at all closely” over the years, you’ll recognize the hollow triumphalism of successfully played. (In this case, the comeback was so extraordinarily successful that the coach, Sebelius, fell on her sword to protect the owner, Obama, by resigning to spend more time with her family, but never mind that.) And if “nobody knows,” it’s not because the Democratic nomenklatura not so much , as .
So in the second paragraph comes the reveal: Krugman’s metric for success is signups; the famous lowballed 6 million that turned into 7 million and change. (Never mind the oddity of taking a metric from and applying it to health care policy; we’ll get to that.) And in some way this makes sense: Numbers are obviously important, as : “[P]eople who actually know how to read budget numbers weighed in, revealing it as a piece of mean-spirited junk.” The problem here is that the ObamaCare numbers are soft, as this blog has consistently pointed out, and about to get softer.
First, and remarkably, much of the ObamaCare sign-up coverage is based on privatized data; people writing the “comeback story” aren’t relying on direct numbers of signups from either the insurance companies or the famously re-engineered ObamaCare website (); they are relying on surveys done at one remove, from the and . Not that there’s anything wrong with using private polling data to write the narrative for public policy; it’s just that the administration has earned a measure of skepticism in this regard:
The administration has always gamed the ObamaCare numbers, from the first day when they scammed us with . Then they gave us counts of people who’d pressed Submit buttons for enrollment on the website, but hadn’t actually paid for their policies (which (), and . . Or have cancelled, since ). Then too, there’s the issue of , as opposed to those who actually increased the net number of those covered. To be fair, !
To be fair, sign-ups are hard to measure, because of Obama’s intrinsic (and needless) complexity as a Rube Goldberg device, (). However, even assuming RAND and Gallup did their work totally at arm’s length from the White House, it would be nice to know that they took all these factors into account in their survey methodology. (There’s no possibility of getting the number of the newly insured from the ObamaCare database itself, because oddly, or not, one for the website, one for paper signups.) The bottom line is that ObamaCare met, or slightly overshot, the original goal for signups that CBO set back in 2010; and that goal is preposterously low when set against people’s need for care. Another such great comeback story and .
Anyhow, the signup numbers are soft, and they’re about to get softer:
The , the authoritative source of data for more than three decades, is changing its annual survey so thoroughly that it will be difficult to measure the effects of ’s in the next report, due this fall, census officials said.
The changes are intended to improve the accuracy of the survey, being conducted this month in interviews with tens of thousands of households around the country. But the new questions are so different that the findings will not be comparable, the officials said.
An internal Census Bureau document said that the new questionnaire included a “total revision to health insurance questions” and, in a test last year, produced lower estimates of the uninsured. Thus, officials said, it will be difficult to say how much of any change is attributable to the Affordable Care Act and how much to the use of a new survey instrument.
( argues the changes will make the Census a more accurate measure of who has insurance; argues that trend lines will be obscured. And where’s the triumph in churn?)
The bottom line is that Krugman’s metric for “one of the great comeback stories of public policy” is soft, and Krugman the economist — the scholar — has to know that; but, sadly, Krugman the hack doesn’t care.
Of course, it’s not enough just to have a metric, and Krugman the economist surely knows this; you’ve got to have a metric that’s fit for the purpose as well. So why on earth is ObamaCare signups the right metric? (Aside from the public relations aspects of winning the expectations game, of course.) The Affordable Care Act is the Affordable Care Act, after all; one would think that the key metric would be people who get care that didn’t get it before, even more than people getting insurance that didn’t have it before. It’s as if Krugman measured the success of D-Day by how many troops went ashore, as opposed to whether they were able to dig in and hold ground. But no; in the crazy pants neo-liberal world that Krugman lives in, along with the entire political class, sick people getting care are a problem labelled adverse selection. So much for “ policy,” eh?
From triumphalism, Krugman shifts to pop sociology. He’s perplexed:
Over the weekend I had dinner in NYC with some very smart, sophisticated people [among them, apparently, none of Thomas Friedman’s cab drivers]; yes, all of them liberals. And almost everyone in the group was under the impression that Obamacare is still going badly — they wanted me to tell them whether it could still be turned around.
But anyway, back to the mystery: here we have smart, pro-reform people living in a state where reform is going really well. And they don’t know it!
In part this may reflect the Obama administration’s lackluster job so far in getting the word out. But it also, I think, reflects a persistent anti-ACA tilt in news coverage.
Come now. Is it really likely that the “smart, sophisticated” people round Krugman’s table are tuned into FOX or Limbaugh all day? I don’t think so. In fact, they’re probably reading Krugman’s column religiously; most “liberals” do. I’d like to proffer an alternative explanation.
Most people who, like Krugman, are in the political class, will never encounter ObamaCare (let alone ). Krugman’s dinner companions get their health insurance through their employers; it’s part of being on the inside, as a tenured professor, a think tank “fellow,” a top-tier newspaper reporter, or a highly valued new media person at a startup. However, I’m guessing that Krugman’s companions also have family, relatives, friends, or acquaintances who are not so lucky, and in consequence they are sensing vague rumblings of discontent in the zeitgeist, a disturbance in the farce. :
I recently attended a younger cousin’s birthday party. My relatives sat around and compared plans. This group was a mix of ages, employment situations, number of dependents, personal wealth. The bad news for the Democrats is that no one likes Obamacare. Not one of them…. It turns out that I have the worst plan at the highest price. One cousin had to change her doctors completely. Another cousin has a serious heart condition but hasn’t landed any work yet, so, no coverage. When his prescription from another state expires in August, he’s screwed. Another cousin just lost his job. He’d been working for 6 months but just when his health benefits were supposed to kick in, he was laid off. How conveeeeenient. Ironically, it is my self-employed cousins who have the best policy. We share the same insurance carrier but, for some mysterious reason we can’t figure out, he pays something like $450/month for 4 people and has a low deductible. It makes me wonder how the rates are determined.
How do we know this isn’t just a blip, an anecdote? Well, we could look at another metric. Follow the money in :
In its latest projections, the Congressional Budget Office cut its estimate for the cost of the US president’s signature law in 2014 by $5bn to $36bn, saying the government would pay fewer subsidies than expected to people buying insurance.
The cut was mainly due to lower government subsidies for private insurance bought on the exchanges, because the insurance plans available were not as generous as the CBO had assumed.
The budget office had expected the plans available through exchanges to be similar to those that companies provide to their employees. But it said they appeared to have “lower payment rates for providers, narrower networks of [healthcare] providers, and tighter management of their subscribers’ use of healthcare than employment-based plans do”.
In a word: Crapification. I’d argue that enough people have encountered enough crapified ObamaCare policies for word to spread. Even as far as Krugman’s dinner table.
So, to bring matters full circle, Krugman is wrong about everything. His metric for success is not only soft, it’s the wrong metric to begin with. And he’s even wrong in his starting point:
The current state of public opinion on health reform is really peculiar.
No, it’s not peculiar at all. When you force people to purchase a crapified product under penalty of IRS enforcement, it’s entirely natural they’ll resent it, and think ill of the people and the institutions that forced compliance on them. If Krugman were the sort of New Deal Democrat who put all that good will on the Party balance sheet for Obama to piss away, that’s what he’d be focusing on: Not the sign-up metric, but metrics that show whether concrete material benefits are being delivered to citizens by public policy. Instead, he’s epater-ing le Republicans and beating the tribal pom poms.
 And then there’s this. :
The White House is always looking for evidence to show the benefits of the health law, which is an issue in many of this year’s midterm elections. The and the White House Council of Economic Advisers requested several of the new questions, and the White House approved the new questionnaire. But the decision to make fundamental changes in the survey was driven by technical experts at the Census Bureau, and members of Congress have not focused on it or suggested political motives.
Yeah, I’d be shocked (shocked) if “political motives” were involved in any way, especially from the White House and HHS in an election year where the success or failure of ObamaCare was a key issue.
 And speaking of hackery, gives single payer advocate a shout-out:
The latest polls show the country evenly divided on the ACA. Those numbers do obscure that a small but significant percent of the opponents want more reform, not less. They’re largely single payer advocates, supporters of the ‘public option’ or people who just generally don’t think the law went far enough.
Is it possible that single payer advocates have any impact on public opinion? “Peculiar” though that might be?
NOTE “Shoddy Democrat Hack Job from Paul Krugman” contains multiple redundancies. My bad.