• Sometime the WSJ makes it too easy

    I know that David Frum and Jon Chait are having a battle right now to see whose job it officially is to attack WSJ editorials, but I still like to play when health care policy is involved. And today, the WSJ offered up a doozy. It’sTexas and Health Care. Let’s wade right in:

    The attempt to dismiss the Texas jobs record seems to have abated, at least for now, but the episode shouldn’t pass without mentioning the other great liberal theme: More than a quarter of the Lone Star State’s people lack health insurance, and supposedly this is proof that Governor Rick Perry hates the poor, as well as vindicating President Obama’s health-care plan.

    Um, no. Please go back and read any of the pieces I’ve written about Texas and health care. At no time, do I claim – nor do I believe – that Gov. Perry hates the poor. I believe the the policies of his administration have done a terrible job of covering the uninsured and improving the health care system, but that’s not the same thing. The WSJ is constructing a straw man to rail against, right there in the first paragraph, but that’s not representative of why wonks dislike Texas health care policy.

    On top of Democratic criticism, we wouldn’t be surprised if Mitt Romney uses the issue to attack Mr. Perry as the former Massachusetts Governor fights for the GOP Presidential nod. The contrasts are instructive, but the factoid that 26.3% of Texans under age 65 are uninsured—compared to the national rate of 17.2%—could use a little scrutiny.

    Factoid“? That implies it’s false. Is that the stance of the WSJ? I ask because the rest of the piece goes on to say that there’s good reason for this discrepancy in insurance coverage, but here in the second paragraph, they say it’s not true. Which is it, WSJ? Are you calling the census a liar?

    The main complaint seems to be that Mr. Perry is responsible because he has declined to expand Medicaid beyond its original purpose of a last resort for poor women and children. Yet some 17% of the Texas population is enrolled in Medicaid, compared to the national average of 19%. The number of Texans on Medicaid increased 78% between 1999 and 2009, with another big boost recently amid the recession.

    That’s a complaint, but just one of many. You don’t get credit just for increasing the percentage of people you cover on Medicaid. If you have more poor people, then you should have more people on Medicaid. You usually don’t get bragging rights when your state has one of the highest levels of poverty in the nation. That’s another thing I’d want to fix if I were governor of Texas. Plus, The WSJ admitting here that Texas is under the national average for Medicaid coverage, even when it has some of highest percentages of poor people. Seriously?

    It’s easy to reduce the uninsured rate if government simply covers everyone

    That’s not what the PPACA does, WSJ. Nice try, though.

    The point is that there are trade-offs between prosperity and entitlement government. The Texas economy is growing and adding jobs in part because it hasn’t adopted the economic model that Mr. Obama favors: high tax rates on the upper middle class, lots of politically directed investment, heavy unionization and a dominant government role in health care. We suspect most voters would prefer the growth that drives jobs and raises incomes over higher taxes to fund more government services. They certainly prefer it in Texas, as Mr. Perry’s re-election record will attest.

    I’m not an expert in these matters, but at least we’re getting to the heart of the matter. The WSJ seems to believe that you have to choose between people getting insurance and economic prosperity. I think that’s a false choice, but at least it’s honest. Perhaps if the WSJ  had stuck to this thesis the whole way instead of (1) claiming the uninsurance rate wasn’t really true and then (2) claiming it doing a better job than we think , we’d have a different discussion. But the WSJ likes to try all the angles in the same piece, I guess.

    A large part of the Texas insurance problem is a byproduct of its economic choices. Only about 50% of Texans have coverage through their jobs, compared to the national rate of 59%, because the state is home to so many new and small businesses that often don’t sponsor coverage. It is also home to many young people and immigrants (both legal and illegal), who are the least likely demographic groups to have coverage.

    You have to love the spin where far fewer people getting insurance through their jobs is a good thing. The WSJ doesn’t like people getting insurance through the government, they approve of fewer people getting it through their jobs, and they oppose things like the exchanges in the PPACA. Do they just hate insurance?

    None of this is to gainsay the genuine hardships that many of the uninsured face, but we prefer the approach Mr. Obama ran on in the 2008 primaries against Hillary Clinton. Then he argued that people were uninsured not because they didn’t want coverage but because it was too expensive. Health costs are rising in Texas as fast as anywhere, though Mr. Perry has made some progress in attracting doctors to the state with his medical malpractice reforms that have reduced an acute provider shortage in many counties.

    I can’t believe they still have the guts to defend Texas’ malpractice reforms as health care reform. No. The doctors coming to Texas because of that? No. Health care costs? Not contained at all. And here’s a paper from some pretty conservative guys that says the same thing. Let’s finish up:

    The Texas health-care record is not perfect, and in particular its low Medicaid payment rates are straining providers. But the point will soon be moot as Washington moves to run everything via ObamaCare. The chance to increase coverage in Texas and everywhere else through market-based reforms would be a good problem to have.

    I think it’s an unwritten rule you have to end such an editorial with the kitchen sink. We have the Medicaid underpays doctors (which will be fixed by slashing Medicaid, WSJ?). We have the “government take over of health care”. We have the “market-based reforms” will fix everything. As I’ve said before, in Texas you have a situation where uninsurance is high and cost containment is poor. So here’s the thing: If Texas is such an awesome example of the free market at work, why isn’t the opposite true?

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    • The WSJ and TIE largely ignore the main reason for Texas’ education and health care statistics (e.g., massive immigration of socioeconomically deprived groups from Mexico)…Its non-Hispanic rates of uninsured are dramatically lower and so this entire discussion is frustrating given that right and left seems to want to ignore the elephant in the room…

      Texas’ education statistics are similarly misleading. A comparison with Wisconsin is illustrative. White students do better in Texas, black students do better in Texas and HIspanic students do better in Texas but overall, Texas’ scores are significantly lower than Wisconsin…Its no mystery why thats the case and its intellectually dishonest to ignore the obvious…

      • Try again.

        http://www.statehealthfacts.org/comparetable.jsp?ind=143&cat=3

        Ranks in uninsurance:

        White: 3rd worst
        Black:: 3rd worst
        Hispanic: 10th worst
        Other: 7th worst
        Overall: worst

      • The Texas vs Wisconsin test scores are more misleading than you think. You need to look at the number of students who take the test and who avoids taking the test. If you are really interested I think I can find the paper out of Rice where a professor looked at how Texas manages to hide its lower performing students on test days. However, it is hard to manipulate graduation rates, and Texas has the lowest in the country.

        Back to health care, we do have a choice. The Texas model with high costs AND low levels of care, or almost anything else.

        Steve