Political Arithmetic: Why Math Sucks for Obama and is Important for Ranked Choice Voting

Political science students think math sucks, and so do many politicans!  Yet the fate of Barack Obama, Obamacare, and Rank Choice Voting all resident in their numbers.  Let’s think about how this is the case.

Obama and Obamacare
    Health care reform and Obamacare is really all about numbers.  This has been pointed out several times in the past.
    Health care reform is a necessity in the United States.  America spends about 19% of its GDP on health care or about $2.97 trillion dollars annually.  France is the next most expense at 11.6% of its GDP and it has universal coverage.  America’s population is aging.  Right now the a median age in the US is 37, expecting to rise to 38.7 over the next 20 years as Baby Boomers age. With that aging comes increased health care costs.  US GDP expenditures on health care will continue to rise to well over 20% unless something is done.  Thus, reform of health care was a major priority for Obama.  If we could achieve near universal coverage and cut health care spending even to the level found in France (a one-third reduction in spending), that would free up near one trillion dollars per year to invest in the economy or simply to save.
    For Obamacare to work one needed to achieve near universal coverage by getting many young healthy people otherwise not insured into the health care market.  Increase the insurance pool of those healthy and the insurance markets set up with the health care exchanges will work.
    Yet all of this is now falling apart because of other political math.  The federal health care exchange web site is a mess, producing confusion and too few people who have signed up.  Additionally, after candidate Obama promised the American public if they liked their health care plan they could keep it, millions are receiving notice that their current plan is being cancelled.  The president’s approval rating is falling, over 50% think he is not trustworthy, and his own Democrats in Congress are worried about 2014 and want to act.  Thus, last week Obama issues an executive order asking insurance companies to keep their old policies in effect for one more year.  In essence, Obama is delaying by one year requirements for Obamacare, similar to requests pressed by Republicans only a few weeks ago during the shutdown.
    Here is the math rock and hard place Obama is behind.  First, the request to the insurance companies is merely a request and not an order.  Second, how will cancelled policies be reinstated?  Third, the request is only for a year, thereby pushing the cancellation problems into the center of the 2014 elections.   Thus, the order to delay Obamacare is the product of political necessity but it solves little.  Morever, by pushing the delay it potentially upsets the actuarial numbers that insurance companies need to make the policies work at their current rates.  If people keep their current policies then those enrolled in the new health care exchanges may see their rates go up even more.
    Finally, Obamacare was originally supposed to increase coverage by several millions.  Best estimates by the Census Bureau (as I discussed recently in a blog) are that the numbers of people who will actually gain coverage will be far less than thought and because so little thought was given to increasing the supply of doctors and health care providers there are indications that costs will increase over time.  Bottom line: there is little evidence that Obamacare will trim health care expenditures, bend the cost curve, or really lead to a dramatic increase in the numbers insured, beyond certain populations.
    Okay so here is one last number and thought.  What do we do in a post Obamacare world if the Affordable Care Act collapses on itself?  What if one had simply taken the original 2,000 page law and instead did three things: 1) Allow young adults to stay on their parents policy until  age 26:  2) bar denial of coverage for pre-existing illnesses; and 3)   Allow anyone to enroll in Medicaid and pay for its benefits?  My guess is that this legislation would have totaled about 100 pages and achieved far greater results than Obamacare.

Ranked Choice Voting
    RCV in Minneapolis was all about math too. Some numbers to consider.
    First, had the rules of ballot access been that one needed 500 or more signatures to appear on the ballot for mayor then (based on the final votes on election night) only ten individuals would have qualified as candidates.  Something needs to be done to ensure that only serious candidates who have some support appear on the ballot and many cite the $500 ballot access fee in St Paul as an example.  However, that $500 fee may be unconstitutional.  The Supreme and other courts have struck down excessive ballot access fees as unconstitutional.  Most jurisdictions do fees with alternative signature requirements. This is the better math for Minneapolis–$500 or 500 signatures.
    Second, at 11 PM on election night it was clear that the bottom 29 or 30 candidates mathematically could not win the mayor’s race.  This means that had city charter allowed for it, one could have simply eliminated them on the day after the election, transferred their votes, and the race would have been called then.
    Third, the reason there are no voting machines to do the automatic tabulation is also a product of math.  No two cities seem to run RCV the same way, precluding vendors from making machines that can be approved by the Department of Justice for use in elections.

    Overall, do the math!  Politics is often about numbers that do or do not add up.

Obamacare: Republican Tragedy, Democrat Farce

By now everyone knows that federal roll out of the Affordable Care Act (Obamacare) health care exchanges has been a disaster. But Obamacare is also a tragedy and a farce.  A tragedy because it is a horrible policy, a farce because it is now forcing Democrats to defend what was essentially a Republican idea.
    The Affordable Care Act is a Republican idea.  Obama himself acknowledged that during his 2012 presidential campaign, repeatedly reminding Mitt Romney that the Affordable Care Act was based significantly upon the policy he signed into law as Massachusetts governor.  But Romneycare’s origins goes back to the 1990s–a policy alternative to the Clinton’s failed healthcare proposals.
    The problems with the Affordable Care Act rests with two original design flaws in the law.  First, the legislation was meant to appease business groups and build on an existing system of health care insurance.  There were too many moving parts, too much capitulation to the industry for the law to work. It was essentially a free-market approach to delivering insurance, giving big insurance companies the opportunity to make more money by selling insurance to the uninsured.  The profit motive of private interests and the free market would solve our health care crisis.  This belief lead to a second and more fundamental problem residing in the assumption that economic markets and competition can deliver health care in an efficient, equitable, and affordable fashion.  The fact that the current health care delivery and insurance system is the most expense in the world with 48 million uninsured and mediocre outcomes attest to that.  The Affordable Care Act is a testament to a foolish belief that market mechanisms will solve health care problems. 
    The Affordable Care Act assumes that consumers can make choices about health care and will buy insurance if affordable.  It assumes that insurance companies will offer policies if markets exist.  The law assume that consumer choice and vendor competition will produce savings.  None of this was true before and there was no reason to think that it should have worked under this act.  If anything, the Affordable Care Act speaks to the limits of free market approaches to delivering vital government services such as health care.  No one in their right mind thinks the US military should fights wars and make a profit doing it, or that police and fire departments should let market mechanisms determine how the bad guys are caught and fire put out.   But Obamacare is a quintessential business pro-business free market idea.  Even the subsidies for the poor are pro-business–if individuals cannot afford health care the government will subsidize it–with the money going to private business.  What a windfall for the private insurance profit margin!
     If these design flaws were not bad enough, the Act has three other problems in terms of cost, coverage, and outcome.  First, the Act does little to address costs.  Currently the US spends 19% of the GDP on health care–we have by far the most expensive health care delivery system in the world.  The next closest are countries such as Canada and France at around 12% GDP, but with universal coverage.  Obamacare is supposed to reduce costs by insuring everyone, thereby reducing emergency room visits and encouraging people to visit doctors before a problem gets too serious.  There are also some provisions in the Act that are supposed to cut costs and in general the entire concept of the health care exchanges is that competition will pressure down costs.  All great theory, but as pointed out in a terrific recent article in special issue of Public Administration Review devoted to Obamacare, these ideas have little empirical foundation and actually most of them were already shown to be ineffective in reducing costs when the Act was being debated.
    Maybe short-term health care costs will go down but there is no evidence that longer term Obamacare will “bend the cost curve.”  On top of that  throwing millions of new consumers into a market with no plans to increase the supply of primary care doctors and nurses means there will be pressure to serve more people with existing resources.  The Act also does nothing to address the going health care needs of aging Baby Boomers who will pressure the health care delivery system.  In effect, the law fails to account for the demographic forces significantly driving up health care costs in the system.
    Additionally, Obamacare is far from universal coverage.  Remember initially that out of fear that universal coverage would lead to illegal aliens jumping the fence along the Mexican border to get free medical care in America ,the 12 million or so undocumented individuals living in America are not eligible for coverage, leaving them with the choice to self-deport themselves back to Mexico.  Many Republican states are also choosing not to extend Medicaid coverage.  The result?  While currently about 83% of individuals in America have health care insurance from their employer, through government, or purchased privately, at best Obamacare will push coverage up to about 90%.  At best, the Affordable Care Act does not even cut in half the number of uninsured in America.  It makes a good dent, but passage of the Act expended so much political capital to achieve so little.
    Finally, the Act does little to address the root cause of so many health care problems–poverty and poor life style choices.  Poverty leads to a host of problems that increase health risks, including malnutrition and homelessness.  But Americans are fact and lazy–we eat, drink, and smoke too much.  Obamacare does nothing to address these issues, problems that health care officials say we need to if we are to really reduce costs and improve outcomes to make America more healthy.  In effect, the act does almost nothing to address preventive or public health issues, again adopting a free market approach that individuals should be free to make their own health care choices.
    Despite all these problems, Democrats and their media apologists defend the law.  They say the law can be fixed or improved over time.  That the law was the camel nose under the tent to further reforms or that–to use the great line that often justifies bad laws–“The good should not be victim to the perfect.”  The reality is that Obamacare was a bad law or idea from the start–it was a bad Republican proposal that the Democrats have now embraced.  Couple the original design flaws along with so many self-inflicted wounds in implementation and so many problems forced upon Obama (a massive Republican effort to destroy a law they originally embraced) and one has a recipe for Democrats going down in 2014 or 2016 because of Obamacare.
    Thus the tragedy and the farce of Obamacare might also have an irony too it–Democrats are embracing a Republican idea and may lose politically because of it and Republicans who originally designed the ideas for Obamacare are now opposing it and may win politically.