Stephen Moore (Heritage, of course) can't even get his cherry-picked data right UPDATED

If you have had the stomach to read the malarkey that the Heritage Foundation puts out, you have no doubt noticed that many of their publications are, well, fact-challenged. Just looking back at this blog, there are stories on how Heritage wants us to think poverty is swell, and multiple versions of how Heritage did not pioneer the ideas underlying the Affordable Care Act.

Today, I turn from Obamacare godfather Stuart Butler to the new Heritage chief economist, Stephen Moore. In a great diary at Daily Kos, SantaFeMarie sums up the sordid story of Moore's July 7 column in the Kansas City Star where, trying to defend himself and Arthur Laffer from the well-deserved ire of Paul Krugman, he claims that 0/low-tax states have seen better job growth than high-tax states. In the original article, he wrote:

No-income-tax Texas gained 1 million jobs over the last five years, California, with its 13 percent tax rate, managed to lose jobs. Oops. Florida gained hundreds of thousands of jobs while New York lost jobs. Oops.

I hope you're sitting down. Although this article was written in July 2014 (and the original version, in Investors Business Daily, appeared July 2), the "last five years" Moore is referring to are: December 2007, the first month of the recession, to December 2012. As you no doubt know, employment data is released monthly, with state-by-state numbers available at a one-month lag from the national numbers. So April or May 2014 was available to Moore when he wrote. But he didn't use that 16 or 17 months' worth of data.

Misleading point #1: This choice of dates excludes California's excellent economic performance subsequent to its 2012 tax and minimum wage increases, as Paul Krugman analyzed in his most recent column. As Star editorial writer Yael T. Abouhalkah (who has long covered everything from fiscal policy to tax increment financing) points out, since Moore's ending date of December 2012, California has added 541,000 jobs, while Texas has an additional 523,400. "So, high taxes are good?" he quipped.

Misleading points #2 through #4: Within Moore's chosen "last five years," he still managed to misstate job performance by over 1.2 million jobs. #2: Texas did not gain "1 million jobs," but only 497,400 (off by 502,600). #3: Florida did not gain "hundreds of thousands of jobs," but lost 461,500, just 30,000 less than the much large California economy (off by at least 661,000). #4: And New York did not lose jobs at all, but added 75,900 (off by 75,900, being generous).

Oops.

On July 24, the Star published a corrected version of Moore's article which, according to Abouhalkah, Moore signed off on. Moore does not acknowledge that the corrections destroy his argument. On Friday afternoon, July 25, I sent a contact form to the editors at Investors Business Daily asking if we could expect a similar correction there. I'll keep you posted.

UPDATE: It's now the evening of July 31, and I have received no response from Investors Business Daily. Nor has Columbia Journalism Review, which reports that the Star's editorial page editor does not plan on using anything from Stephen Moore again (though this could be moot, as she is retiring). And you can see here that there has been no correction made to Moore's original article, which still includes the stats which are 1.2 million jobs off.

Read more here:http://www.kansascity.com/opinion/readers-opinion/as-i-see-it/article685284.html#storylink=cpy

Watch this Link: Will Heritage Scrub Its Obamacare History?

Mike the Mad Biologist leads me to a host of articles on the crazy things going on at Heritage Foundation, especially since former Senator Jim DeMint of South Carolina took over as president of the organization. Mike quotes Alex Pareene at length on how the rise of MBAs running both the Foundation (DeMint) and Heritage Action (Michael Needham) has turned Heritage from a respected think tank into a mainly political organization of the hard right. Pareene, in turn, leads to a good analysis by Julia Ioffe in The New Republic.

As regular readers know, Heritage is an organization that I've already lost most respect for, it being famous both for proposing Obamacare's main components and denying that it is responsible for the individual mandate. This has been well-debunked in both Forbes and The Wall Street Journal, by Avik Roy and James Taranto respectively.

My modest contribution was to note that the January 1989 research report Taranto found in the Heritage archives was actually noted on its cover, "Revised Edition." This pushes the original research back into 1988 at least and clearly refutes Stuart Butler's claim that the individual mandate was a response to Hillarycare. In fact, it was a response to the considerable political groundswell for single payer in the 1980s.

The question is how far the deterioration of the Heritage research mandate will go. I think one clear indicator would be if Heritage decides to take the 1984 "Ministry of Truth" route and delete the research from its website. So far, it has yet to stoop that low. But when "A National Health System for America, Revised Edition," can no longer be downloaded, we will know another big step in the hyper-politicization of Heritage has taken place. Should it happen, and you need a copy, email me and I will send you a copy of the pdf document on a "fair use" basis.

You will know it has happened when you can no longer download the report from

Here

Republicans' "Market-Oriented" Health Care Reforms Won't Work, Part 2

Last time we examined a common conservative "solution" to the country's health care problems, allowing insurance companies to sell policies across state lines. What we found, though, is that this would lead to a race to the bottom in state regulation of insurance products, and that there is no reason to think that further marketization of healthcare in the U.S. will lower costs.

Today, we turn our attention to tort reform. It figured prominently in Karl Rove's Wall Street Journal article last week (paywalled). This has been a conservative theme for so long that most states have already done it. In fact, since 1986, 39 states have limited noneconmic damages, punitive damages, or both, making it hard to see how further tort reform can yield much in terms of gains that haven't already been achieved. The current conservative battle cry is for federal tort reform, in other words forcing the states to reduce protection against medical malpractice whether they want to or not.

And make no mistake, malpractice happens a lot. According to a New York Times article by Dr. Sanjay Gupta, about 200,000 people die each year because of what he calls "medical mistakes," up from an estimated 96,000 in 1999. This makes it the third-leading cause of death in the United States, after only heart disease and cancer. Yet Republican proposals would reduce the legal rights of their survivors, and of the many more patients who are only sickened or injured, but not killed, by malpractice.

The conjunction of plenty of malpractice with plenty of tort reform should make us skeptical that the cost of malpractice laws can be reduced much more. According to Aaron Carroll, the biggest proportion of the estimated $55.6 billion (a figure Rove accepts, by the way) that malpractice adds to the health care system comes from defensive medicine, for $47 billion of the total. We should start out by noting that this is only about 2.35% of the country's $2 trillion health care system. While it isn't nothing, we are talking about approximately $150 per capita, compared with U.S. spending of over $3000 per capita more than the OECD average for doctors and hospitals alone. But if tort reform has already reduced a lot of malpractice exposure, how much more of that $47 billion can doctors cut with even more tort reform? Not much, I'd argue.

No analysis of tort reform can go without mentioning Texas' 2003 Big Bang of tort reform, which conservatives widely tout as a stunning success. A July 2013 Heritage Foundation report by Joseph Nixon and the Texas Public Policy Foundation claims that not only did tort reform result in many doctors moving to Texas, but that tort reform "is the foundation of the Texas economic miracle." (I've expressed my skepticism of a Texas miracle before here.) It claims that there has been substantially increased access because of all the new physicians.

However, there are a couple of teenie-weenie problems with this analysis. First of all, as Politifact pointed out when Governor Rick Perry was running for President, the number of doctors per capita rose much more rapidly in the 1990s than it has since tort reform in 2003. From 2003 to 2011, growth in the number of doctors barely outpaced population growth, 24% vs. 20% over those eight years. Despite Nixon's claim that doctor growth was double population growth since tort reform, Politifact shows that it was only during the 1990s that this held true. Perry's "false"-rated claim that the state had gained 21,000 doctors since tort reform was based on ignoring the distinction between doctors licensed in the state and those who actually practiced in the state. Nixon's report appears to do this as well, because he says, "By the end of 2013,...Texas will have close to 60,000 doctors to care for its citizens." However, the Texas Medical Board source that he cites shows in January 2013 only 52,707 licensed doctors were practicing in Texas. The May update, which I presume was not available when he wrote, shows only 528 more. Texas will not be anywhere near 60,000 by the end of the year.

Second, while the state has improved its ranking since 2003, in 2010 the state had only 216 doctors per 100,000 population, far below the national average of 273 This makes it #40 of the 50 states. Massachusetts, a state conservatives love to hate, and which has not had either kind of tort reform, had 474 doctors per 100,000 population, first in the nation.

Third, contra Nixon, having more doctors is not the same thing as having access to health care. There is the little matter of insurance. Texas continues to have the highest rate of uninsured people in the country, 24% of its total population, which is six times as high as Massachusetts, with 4%.

Finally, tort reform has not done anything for the cost of medicine. As Aaron Carroll (link above) shows, since 2003 Medicare spending per patient  has risen more rapidly in Texas than for the country as a whole. He sends us to an analysis by Public Citizen, which produced the table he uses:



Source: Public Citizen, via Aaron Carroll

Summing up, tort reform has not produced more doctors (in Texas, population growth did), does not increase access because it does not give people insurance, and does not reduce costs. Even more tort reform isn't going to give us any savings, either, though it will reduce consumer protection for the hundreds of thousands of victims of malpractice annually.

Don't believe the hype.

Cross-posted at Angry Bear.

Conservative Refutation of Butler/Heritage Health Care Revisionism Continues

The pile-on continues. As I discussed in February, Stuart Butler of the Heritage Foundation wrote a breath-taking op-ed in USA Today (via Don Taylor) denying that he fathered the individual mandate. In fact, his revised 140-page research paper was published January 2, 1989, before President George HW Bush came into office, let alone President Clinton, whose proposals Butler says his research was directed against. Two conservatives, Avik Roy of Forbes and James Taranto of the Wall Street Journal, played strong roles in locking down the point that Butler was the first to propose the mandate.

Today, J.D. Kleinke of the American Enterprise Institute goes straight to that 1989 report in a New York Times opinion piece to once again lay the mandate at the feet of Heritage. And why not? According to him, the Affordable Care Act is a conservative's dream.

The rationalization and extension of the current market is financed by the other linchpin of the law: the mandate that we all carry health insurance, an idea forged not by liberal social engineers at the Brookings Institution but by conservative economists at the Heritage Foundation. The individual mandate recognizes that millions of Americans who could buy health insurance choose not to, because it requires trading away today’s wants for tomorrow’s needs. The mandate is about personal responsibility — a hallmark of conservative thought.

 Kleinke argues that Romney's incoherence on health care stems precisely from rejecting his accomplishment in Massachusetts. Romney can't offer anything better than the ACA because it is the only conservative way to overcome the problems of the health care market while remaining based on the market and individual responsibility. With no single payer and no public option, it is not surprising that, as he puts it, "the health insurance industry has been quietly supporting the plan all along."

Aside from his odd notion that single payer represents a "government takeover of health care" (Canada's Medicare is not the United Kingdom's National Health Service), Kleinke's column is on the money: historically, the mandate was developed by Heritage economists, the ACA more broadly relies on conservative rather than liberal principles, and many liberals have been unenthusiastic for just that reason. Heck, I'm unenthusiastic (single payer!). But it's a big improvement over the status quo that is already providing benefits to millions of people, whether for young adults, the millions of consumers getting rebates due to the medical loss ratio rule, or for seniors getting rid of the donut hole and gaining free preventive care.

Conservatives Refute Butler/Heritage Revisionism

@gregvarner points me to a new article at Forbes where Avik Roy tries in vain to find a reference to the individual mandate before the Heritage Foundation, specifically Stuart Butler, started publishing research on it in 1989. Citing the same 1989 lecture I did (and Krugman before me) in my last post, Roy concludes:

Based on my research, I see no contravening evidence to the claim that Stuart Butler and Heritage were the first people to advocate the individual mandate, in the context of a private-sector health-care system.

Roy is at pains to say that Heritage and Butler are now right to oppose the individual mandate, but nowhere does he give any evidence that they changed their minds on it prior to President Obama's election. Unless he (or Butler) give such evidence, it will be hard to take seriously the claim that the "change of heart" isn't merely political opportunism.

As I mentioned in my last post, you can't give a lecture on something without previously researching it, and Roy gives an update linking to James Taranto at the Wall Street Journal, who also isn't buying "Butler's claim of unoriginality," and who finds the research piece that preceded the lecture. "A National Health System for America," edited by Butler and Edmund Haislmaier, is a major 140-page research document. Although it is dated on the Heritage website as January 2, 1989, as Taranto says the Washington Post news story about the book states it was released June 1 of that year (which I verified using the Nexis subscription service). What Taranto does not notice is that this document is clearly labeled on its cover "Revised Edition." This could well push the original version and the original research back into 1988 or earlier.

Not only that, Taranto finds multiple elements of the Affordable Care Act in the research monograph, including its enforcement mechanism.

To Heritage's credit, it has not scrubbed its website of either the lecture or the research document, but the fact remains that these documents appear to be the ultimate source of the individual mandate. Butler has yet to cite another source or acknowledge that he was working on it in the 1980s, not just the 1990s. As Taranto concludes in Butler's case, "Acknowledging error is a sign of integrity, but you have to be truthful about it." Amen to that.

Heritage Doubles Down on Individual Mandate Denialism

As I reported in July, the Heritage Foundation has been bellowing against the Affordable Care Act despite the fact that the critical elements (individual mandate, community rating, and subsidies so everyone can afford insurance) were first proposed by -- the Heritage Foundation!

In USA Today (via Don Taylor) Stuart Butler, author of the Heritage lecture linked above, says "Don't Blame Heritage for ObamaCare Mandate." He writes:

The confusion arises from the fact that 20 years ago, I held the view that as a technical matter, some form of requirement to purchase insurance was needed in a near-universal insurance market to avoid massive instability through "adverse selection" (insurers avoiding bad risks and healthy people declining coverage). At that time, President Clinton was proposing a universal health care plan, and Heritage and I devised a viable alternative.

My view was shared at the time by many conservative experts, including American Enterprise Institute (AEI) scholars, as well as most non-conservative analysts. Even libertarian-conservative icon Milton Friedman, in a 1991 Wall Street Journal article, advocated replacing Medicare and Medicaid "with a requirement that every U.S. family unit have a major medical insurance policy."

My idea was hardly new. Heritage did not invent the individual mandate.

  What this self-serving narrative omits, as Taylor points out, is any mention of Butler's original proposal, linked above, from October 1989. This is more than three years prior to the Clinton health care legislation he claimed to be opposing. Butler's entire article puts his support of the mandate in "the 1990s," despite the fact that he had to have been conducting research on it prior to lecturing on it in 1989. Indeed, he cites no publication prior to his own where an individual mandate was proposed. That doesn't mean one isn't out there, but he gives us no reason to think there is.

He continues:

Additionally, the meaning of the individual mandate we are said to have "invented" has changed over time. Today it means the government makes people buy comprehensive benefits for their own good, rather than our original emphasis on protecting society from the heavy medical costs of free riders.

 This is a very strained distinction. I'm not aware of the President or any other supporter of the mandate (I myself would prefer single payer) claiming people are to be forced to buy insurance "for their own good." Just as with Governor Romney's health care reform in Massachusetts, the idea behind the individual mandate remains preventing free riders from not getting insurance until they are sick. That is crucial in making it possible to require insurance companies to insure anyone regardless of pre-existing conditions.

Taylor's colleague at The Incidental Economist, Aaron Carroll, is even more skeptical than Taylor. Carroll argues that nothing in Butler's article supports the view that the mandate in unconstitutional, least of all the claim that the mandate is "for their own good." He also rejects Butler's claim that the Heritage mandate used carrots while the ACA's uses sticks as "just semantics." Whether you raise taxes and give a credit to those who buy insurance, or don't raise taxes and penalize those who don't buy insurance, the bottom line, Carroll points out, is the same.

While I guess it is in some way intellectually appealing to see Butler try to explicitly defend his changed position, the fact of the matter is that his defense is entirely bogus. You don't craft a policy in 1989 to defend against a proposal in 1993 by a President who hasn't been elected yet. No, the truth of the matter is that the individual mandate was the conservative approach to expanding health care access right up until the time President Obama advanced it as his own. Then it became both bad policy and unconstitutional, to boot.

And at night all cats are gray.