Tuesday, March 14, 2017

The CBO projections and liberal/conservative differences in healthcare objectives

Time for some political science references.

CBO says that in the long term, 24 million fewer people would have health insurance under the GOP healthcare proposal, combining the dropped mandate and scaled back subsidies and Medicaid.  To liberals, that's scandalous.  To conservatives, that's the point.  And here is where we get into the distinction I have addressed many times before, coming from Donald Stokes and his 1963 article, "Spatial Models of Party Competition," published in the American Political Science Review.

Stokes distinguished between positional issues and valence issues as follows.  Positional issues are the issues about which voters fundamentally disagree about the objective.  Should abortion be legal or not?  Valence issues are the issues about which voters agree about the objective, but disagree about how to get there.  An example of a valence issue would be a high rate of economic growth.

Healthcare policy is a positional issue, not a valence issue.  Reducing the number of uninsured people through wealth redistribution is a positional preference.  You have to accept the premise that you are having the government stick guns at peoples' heads (usually just implied) to take their money in order to use that money to save lives.  (And mushy-headed, gun-fearing liberals like to pretend those guns aren't involved because they don't see the guns, but that's another issue for me to prod them about...)  That is a moral tradeoff.  Robin Hood-ism.  All policy decisions involve moral tradeoffs.  The liberal position involves something kind of like armed robbery since taxation is backed up by the threat of violence with the government's armaments.  The conservative position involves letting people die because they made the mistake of being born poor, and yes, birth circumstances have a lot of predictive power.  Tradeoffs.  Yes, the Republican bill (Trumpcare, Ryancare, whatever) reduces the number of insured people.  That's because reducing the number of uninsured people without regard to the method is not a valence issue.  It is positional.

The CBO headlines sound bad to liberals, and they won't sound good to anyone paying attention who doesn't have well-formed opinions, although most people don't pay attention, and most people have no clue what the CBO is.  These certainly aren't the headlines Republicans would want if they could choose (which was why they spent so much effort trying to discredit the CBO in advance).  However, the dynamic at work here is a simple one.  Reducing the number of people who receive taxpayer-funded government subsidies is the purpose of the bill.  So, treating the CBO score as though it were a measure of the quality of the bill, based on the premise that the number of people covered was the point-- like it was a valence issue-- misses the point.


  1. Some of us mushy heads are perfectly fine acknowledging those guns.

    Something about the definition of government being an organization that has a monopoly on the legitimate use of force in a given jurisdiction.

    (But then, we all know that you only included the gun thing in there to poke me)
    (because everything is about me)