Every now and then, Jeff will listen to Rush Limbaugh despite knowing full well that Rush will undoubtedly say something so false and inflammatory that Jeff will turn off the radio in disgust. Likewise, I have a friend who will occasionally turn on Glenn Beck’s Fox News show even though he knows that Beck will anger him to the point that he starts yelling at his television. Yet I would guess that greater than 90% of the people who tune into these programs do not have such visceral negative reactions. It’s an odd phenomenon, really, and it seems to suggest that H.L. Mencken was right: no one ever went broke underestimating the tastes of the American people. Or, perhaps more accurately, no one ever went broke mindlessly regurgitating talking points aimed at the lowest common denominator of the Republican party.
I mention all of this for two reasons. First, because I don’t think it is ever a bad idea to point out when people are not thinking critically about something and are, instead, allowing someone else to feed them soundbite answers. Second, I think some version of this phenomenon explains why the Republican candidate to replace Robbie Wills in District 46, David Meeks, is in my Twitter feed.
My first and only encounter with him on Twitter was following a comment (I’m paraphrasing) that there should be no exceptions to an anti-abortion law for rape, incest, or the health of the mother because “life is life,” and it was all worth protecting. I said that I assumed his position on the issue also made him anti-death penalty; I mean “life is life,” right? Meeks started to crawfish and said that the death penalty was an ok exception, and then he accused me of taking the statement “life is life” out of context. (Context: “@bluehogreport That is why I said MOST women have a choice. Regardless, life is life. I can’t in good conscience make exceptions.”)
In the span of six or seven additional Tweets, Meeks managed to demonstrate a fundamental lack of understanding of the concepts of logical consistency and moral relativism, of the difference between a scholarly study of empirical data and a platitude-filled article on a pro-death-penalty website (he referred to both as “studies”), and of the irony in ending a debate over his own failures of logic by saying that he “choose[s] to believe in deterrence.” Because, you know, choosing to believe something despite all the evidence to the contrary is the hallmark of an enlightened and rational mind.
Anyway, at that point, I stopped replying to him or responding to any of his Tweets. Yet, for whatever reason, I have kept him in my feed. I can only assume it is because he does not seem to be overly bright, and the fact that he can be a viable candidate for elected office irritates me multiple times per week.
Which brings me to the point of this post. Last Friday, Meeks Tweeted:
Ooooh. $750+ million?! That sounds like a HUGE number to expect widdle ol’ Arkansas to cover. Man, this study must’ve ripped the pro-HCR crowd a new one with numbers like those. I could hardly wait to see how strongly the study opposed the reform bill. I found the document in question — Medicaid Coverage and Spending in Health Reform — and there it was, right there on page 1 (page 3 of the .PDF):
- Medicaid expansions will significantly increase coverage and reduce the number of uninsured
- The federal government will pay a very high share of new Medicaid costs in all states
- Increases in state spending are small compared to increases in coverage and federal revenues and relative to what states would have spent if reform had not been enacted
Wait…what? “Increases in state spending are small?” How can that be? I mean, David just pointed at a “$750+ million” price tag. Maybe it’s a bait-and-switch. Let’s keep reading. Wait…there it is again, this time on page 3.
Increases in state spending are small compared to increases in coverage and federal revenues and relative to what states would have spent if reform had not been enacted (baseline). Nationally, enrollment is expected to increase by 27.4 percent compared to the baseline. This increase in enrollment far exceeds increases in state spending relative to baseline of 1.4 percent. Due to the large increase in federal matching rates, the federal increases in Medicaid spending compared to baseline are expected to be 22.1 percent with overall spending increases of 13.2 percent. […] The aggregate match rates for Medicaid or the share of total Medicaid spending financed by the federal government is expected to increase from 57.1 percent (under current law) to 61.6 percent; however, states that have had large increases in the number of new eligibles will see the greatest increases in matching rates.
Hmmm. As I flip through this thing, it sure seems like the Kaiser Commission, authors of the report, think that the reforms were a good investment.
For example, on page 4, the report states:
The actual federal share of the costs of the Medicaid expansion varies based on the state coverage levels today, but it is always very high. State with low coverage levels [Like Arkansas. –Ed.] today will see the vast majority of the costs of new enrollment financed by the federal government over the 2014 to 2019 period because most of their increased enrollment is from individuals made eligible by health reform who qualify for the high newly eligible match rate….
Generally, states will benefit from a large influx of federal dollars and new coverage is likely to reduce the need for state payments for uncompensated care.
The actual numbers for Arkansas start on page 10. In a Standard Participation Scenario (wherein we assume “57 percent participation among the newly eligible uninsured and lower participation across other coverage groups”), we see the following for Arkansas:
Percent Reduction by 2019 in Uninsured Adults making less than 133% of the Federal Poverty Level: 47.6%
Spending in 2014-2019 by Arkansas: $455,000,000
Spending in AR in 2014-2019 by Fed Govt: $9,401,000,000
Percentage increase in people enrolled by 2019 over number that would be expected under existing law: 27.9%
Percentage increase in amount Arkansas will be spending in 2019 under new plan over what they would expect to pay under existing laws: 4.7%
Then, on page 11, we get the numbers for an Enhanced Participation Scenario (wherein we assume “75 percent participation among the newly eligible that are currently uninsured…and higher participation among those currently eligible for coverage than in the standard scenario”).
Percent Reduction by 2019 in Uninsured Adults making less than 133% of the Federal Poverty Level: 72.1%
Spending in 2014-2019 by Arkansas: $761,000,000
Spending in AR in 2014-2019 by Fed Govt: $11,523,000,000
Percentage increase in people enrolled by 2019 over number that would be expected under existing law: 39.9%
Percentage increase in amount Arkansas will be spending by 2019 under new plan over what they would expect to pay under existing laws: 7.9%
That’s right: even under the Expanded Implementation analysis, the state would see a Medicaid cost increase of less than 8% while extending basic Medicaid to almost 40% more Arkansans. However, and despite the fact that Meeks cites the cost from this plan, the Enhanced Implementation would require a state that was aggressively implementing the reforms and reaching out to voters, which is something that is almost certainly inapplicable to Arkansas. (More on why in a minute.) Under the Standard Implementation scenario, Arkansas will see a spending increase of 4.7% over what it would otherwise be spending by 2019, but will extend coverage to nearly 28% more Arkansans.
Just for grins, let’s translate this to a real-world metaphor. Imagine you rent an apartment for $700 per month. It’s a decent enough apartment, but at 800 square feet, it is pretty small. One day, you are looking through the paper and you see an apartment for rent that offers you 1120 square feet (40% more) for $756 per month. You’d jump at that opportunity, wouldn’t you? How about if you found a place that offered 1024 square feet (28% more) for $733/month? You’d jump at that chance, too, because it would be foolish not to.
What Meeks apparently fails to grasp (among many, many other things) is the age-old rule in economics that rational people think at the margins. What is important is not some raw number — especially a raw number that you selectively choose because it is higher and, therefore, more “scary” to anyone stupid enough to think that you have the slightest clue what you’re talking about — but whether the marginal increase in cost is outweighed by the marginal increase in value. Increases in the number of people who can get health care by nearly 28% (or 40%) vastly outweigh a corresponding spending increase of 4.7% (or 7.9%), and, anyone who suggests otherwise simply isn’t thinking logically enough to understand marginal costs, or he is trying to mislead others to further his agenda. I’ll give Meeks the benefit of the doubt and assume ignorance over purposefully disingenuous statements, but I will continue to remain appalled that someone who can’t grasp simple economic concepts could be elected to help lead the state.
As for why the Enhanced Implementation scenario (and its corresponding cost) are unlikely in Arkansas, it has to do with an ignorance about this bill that is endemic in Arkansas right now. Recent polling (albeit by right-leaning Rasmussen) shows:
Voters in Arkansas have consistently opposed the health care bill more strongly than voters in much of the rest of the country. Sixty-five percent (65%) of voters in the state now favor repeal of the health care bill, while 30% oppose repeal. This includes 57% who Strongly Favor repeal and 20% who are Strongly Opposed.
The only reasons I’ve heard for favoring repeal are Sarah Palin’s “death panels,” “keep yer gubbamint hands offa mah health care,” and “it’s too expensive for Arkansas.” The first two are stupid at best and don’t deserve discussion. The third one is just wrong. As the very study cited by Meeks explains in no uncertain terms:
States with more modest coverage today — Alabama, Arkansas, Mississippi, Oklahoma, South Carolina, and Texas — will see very large overall (federal and state) increases in spending relative to the current Medicaid base. But even these states will see relatively small increases in their own spending, both because they are low-income states and thus have higher than average matching rates on their current eligibles, but also because of the very favorable matching rate on new eligibles. […] Thus, despite rather substantial increases in overall spending on Medicaid in these states, only a relatively small share of the cost will be borne by the states themselves.
Yet, despite all of this and despite the large percentage of Arkansans who otherwise would have no health coverage at all, Arkansans still tend to favor repealing the HCR bill. If those same Arkansans would take a step back and look at reality, a whole lot of them (say, perhaps, the percentage that will suddenly have health coverage) would change their tune. Unfortunately for them and for Arkansas as a whole, the David Meekses of the world would rather crow about how the sky is falling and attempt to make political hay out of something that is a good thing for the state both economically as well as health-wise rather than helping his potential constituents understand why the bill is a good thing.
At the very least, even if he opposes the purposes behind the bill, I would hope that he would not spread incorrect information. You don’t understand marginal costs and rational economic decision-making? Fine, I don’t care. However, could you PLEASE shut up about the stuff that you don’t understand and not muddy the issue further? The rest of Arkansas would certainly appreciate it, even if they don’t know it yet.