Dog bites man: 270+ health, public finance, and labor economists oppose repeal of health reform.

Another economist expert letter appears, with almost 300 labor, public finance, and health economists opposed to repealing health reform. Read it. Then compare with Republicans’ similar effort last week.

Several of us drafted the below economists’ letter economist letter shown below the fold. It opposes the repeal of health reform. It also rebuts the “job-killing” charge Republicans are making about the Affordable Care Act. We got more than 270 signatures, and counting. With a tiny number of exceptions, we confined the letter to health, labor, and public finance economists. Had we included other public health and health policy experts and clinicians, we could have easily gotten huge numbers.

It makes an interesting contrast to a similar Republican effort here. I hope that readers look at both letters.

Consider the tone and the quality of the arguments. To take an obvious example, The Republican letter criticizes ACA as “A crushing debt burden,” and writes the weasel words “could potentially [ialics mine] raise the federal deficit by more than $500 billion during the first ten years and by nearly $1.5 trillion in the following decade.” They do not acknowledge that the Congressional Budget Office scores the repeal legislation as raising the deficit by $230 billion.

Less obviously, look at who signed. Andrew Sabl has knocked the Republican letter already for its lack of luminaries. That’s not my point. Their list includes some very accomplished people.

Their list does not include many people at the core of health policy analysis and research. With the exception of Douglas Holtz-Eakin, Joseph Antos, June O’Neill and a very small number of others, their list does not even include many of the standard Republican policy experts I would expect to see. Then look through our 270 names. It includes people like Hank Aaron, Alice Rivlin, Kenneth Arrow, David Cutler, Alan Krueger, Jon Gruber, Uwe Reinhardt, Hal Luft, Charles Schultze, and many more. These are not ideologues. They are not only at the top of the profession. These are pioneers in the fields of public finance and health services research who in many ways provided the intellectual groundwork and the empirical research on which current health policy debate is based.

Partisan noise aside, the overwhelming majority of serious health policy and public finance researchers support the Affordable Care Act and want it to work. Indeed, I believe that most Republican policy wonks who would repeal the provisions that cover the uninsured still support the delivery reforms embodied in the new law. The dirty secret of Washington politics is that policy wonks on both sides have much more in common with each other– say on the new Independent payment Advisory Board, or on overpayments to Medicare Advantage plans–than either side has in common with, say, Congressional committee chairs who want to meddle in Medicare reimbursements for surgeries and medical devices.

I hope, as we move forward, that a responsible, incremental Republican opposition emerges that makes possible improvement and genuine negotiation in the implementation of this new law.

This week, Congress is holding hearings on the economic impact of health care reform. We write to convey our strong conclusion that leaving in place the Patient Protection and Affordable Care Act of 2010 (ACA) will significantly strengthen the economy and promote economic recovery. Repealing the Affordable Care Act would cause needless economic harm, and would set back efforts to create a more disciplined and more effective health care system.

Our conclusion is based on two economic principles. First, high medical spending harms employment and economic growth. Many studies demonstrate that employers respond to rising health insurance costs by reducing wages, hiring fewer workers, or some combination of the two. Lack of universal coverage impairs job mobility as well; workers pass up opportunities for self-employment or for positions working for small firms because they fear losing their health insurance or facing higher premiums. Second, the ACA contains essentially every cost-containment provision policy analysts have considered effective in reducing the rate of medical spending. These provisions include:

 Payment innovations including greater reimbursement for patient-centered primary care; bundled payments for hospital, physician, and other services provided for a single episode of care; shared savings approaches or capitation payments that reward accountable provider groups that assume responsibility for the continuum of a patient’s care; and pay-for-performance incentives for Medicare providers.
 An Independent Payment Advisory Board with authority to make recommendations to reduce cost growth and improve quality within both Medicare and the health system as a whole
 A new Innovation Center within the Centers for Medicare and Medicaid Services, or CMS, charged with streamlining the testing of demonstration and pilot projects in Medicare and rapidly expanding successful models across the program
 Measures to inform patients and payers about the quality of medical care providers, which provide relatively low-quality, high-cost providers financial incentives to improve their care
 Increased funding for comparative effectiveness research
 Increased emphasis on wellness and prevention

Taken together, these provisions are likely to reduce employer spending on health insurance. Estimates suggest spending reductions ranging from tens of billions of dollars to hundreds of billions of dollars. Because repealing reform would eliminate the above provisions, it would increase business spending on health insurance, and hence reduce employment. One study concludes that repealing ACA would produce job reductions of 250,000 to 400,000 annually over the next decade. Worker mobility would be impaired as well, as people remain locked into less productive jobs just to get health insurance.

The budgetary impact of repeal would also be severe. The Congressional Budget Office concludes that repealing ACA would increase the cumulative federal deficit by $230 billion over the next decade, and would further increase the deficit in later years. Other studies suggest that budgetary impact of repeal is even greater. State and local governments would face even more serious fiscal challenges if the ACA were repealed, as they would lose substantial resources provided under the new law while facing the burdens of caring for 32 million more uninsured people. Repealing the ACA would thus make a difficult budget situation even worse.

Rather than undermining health reform, Congress needs to make ACA as successful as it can be. This would be as good for our economy as it would be for the health of our citizens.


[for the full list of names, see here]

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

16 thoughts on “Dog bites man: 270+ health, public finance, and labor economists oppose repeal of health reform.”

  1. GOP is not looking to solve real problems. They are looking to create "Obama's Waterloo". If it's good for the american people it's good for Obama and that ain't good for the GOP!

    Why do GOPers hate America? They don't, they just have to destroy it to save it from the clutches of the american people.

  2. Here's the problem. Let's assume that everything you outline above (and in this letter) is absolutely true and accurate. The reality still remains that the polls have consistently showed that the American public don't want this bill, at the very least in its current form. The thinking by the backers of this bill were that it would grow in popularity as time went on. It has not. I'm not sure why the American public don't want it. Perhaps it is simply misinformation. I happen to think it's more than that. My area of expertise is criminal justice policy. In criminal justice, there's an emerging body of research on what is called "procedural justice". The bottom line is that process matters. How you go about something matters. This enormous bill was shoved through the legislature in a rushed and partisan fashion. At the least, Americans wanted to learn more about the details in this massive bill. There are a number of legitimate concerns with it that even Obama acknowledged in his SOTU address the other night. Government has lost legitimacy because of the way they went about this bill. This is a large part of what was going on in our last election cycle. The American people wanted to be heard, not to be told that government or academics know what's best for them (even if government does know what's best for them, which I personally don't believe it does). So the American people were heard in the last election. House Republicans had no other option but to move to repeal this bill. That is why many of them got elected. In many ways, if there's not legitimacy to the process, it doesn't matter if this is a good bill or not, just as if, for example, there's not legitimacy to policing then it doesn't matter whether the police are doing the right thing or not. So all of this academic and political debate about the whether or not the details of the bill or good or will reduce our deficit miss the point altogether. If one thing is for sure, it is that the American people are going to be heard

  3. " The reality still remains that the polls have consistently showed that the American public don’t want this bill, at the very least in its current form."


  4. Harold Pollack wrote: "Several of us drafted the below economists’ letter."

    So clue us in – who do you think is below economists? Our standing has been pretty poor especially for the last couple of years. I find it hard to believe that you were able to find many people who would go on the record as stating, even implicitly, that they are lower!

  5. It strikes me it is only fair to do a similar review of your own list as the Republican list you critiqued- "Of the 200 or so economists signing the letter, the number who teach at the top ten departments is four: Michael Boskin from Stanford (Hoover doesn’t count), Robert Lucas from Chicago (the business school doesn’t count), and two from Columbia. We’ll add the Nobel Laureate (Edward C. Prescott) on an honorary basis. That makes five out of two hundred from top ten departments or the equivalent. On the other hand, Hillsdale College is well represented (four signers), as are conservative think tanks." Your list also has many not at Top Ten Departments and many who are not from Economics department but Policy Schools and Think Tanks (and medical schools). So do the take down of your side similarly to that of the other and I do believe on your preexisting criteria your side comes out better (Good). But otherwise yo are just behaving "smarmy".

  6. Max. Two points.

    1. Your beef is with Sabl, not with me.

    2. Instead of disparaging people, let's go the other way and find really good people who have done directly pertinent work. Here is a partial list academic researchers who signed our letter:

    Henry Aaron, Stuart Altman, Kenneth J. Arrow, David Autor, Frank Chaloupka, Raj Chetty, Paul Cleary, Philip Cook, David Cutler, Brad DeLong, Randall P. Ellis, Judy Feder, Austin Frakt, Jeffrey Frankel, Irwin Garfinkel, Paul Gertler, Claudia Goldin, Michael Grossman, Vivian Ho, Hilary Hoynes, Ted Joyce, Lawrence Katz, Alan Krueger, Robert Lawrence, Arleen Leibowitz, Jeffrey Liebman, Harold Luft, Thomas McGuire, Ellen Meara, David Meltzer, Alan Monheit, Len Nichols, Steven Pizer, Daniel Polsky, Dahlia Remler, Thomas Rice, Alice Rivlin, Christina Romer, Meredith Rosenthal, Cristopher Ruhm,

    Timothy Smeeding, Katherine Swartz, Donald Taylor, Chris Tilly, Paul N. Van de Water, Elizabeth Richardson Vigdor, Kenneth Warner, Barbara Wolfe, Justin Wolfers.

    Bear in mind that political scientists and others were basically excluded. I also left off two Nobel Prize winners and a Clark Medalist from the above little list.

    Find me equivalent names on the Republican list. There are some–not nearly as many.

  7. Impressive list. Good argument on the merits, perhaps. Arguments from authority don't pass muster, however.

  8. "Arguments from authority don’t pass muster, however."

    You really don't know what you're talking about, do you?

  9. Sneering at people who don't like arguments from authority doesn't pass muster, either.

    I think Bux has it: The way the bill passed stank, Democrats were operating on the theory that, even if the public initially objected, they'd like the taste once it was rammed down their throat. Turned out they didn't, voted accordingly, and democratic legitimacy demands that the law be repealed, regardless of whether the "shellacked" Democratic party still thinks it was a good bill.

  10. Wow, Brett, you've packed a lot of fallacies into a few sentences.

    First, arguments from authority are not in and of themselves bad.

    "…democratic legitimacy demands that the law be repealed, regardless of whether the “shellacked” Democratic party still thinks it was a good bill."

    Wrong again.

  11. No, arguments from authority can be arguments in favor of something which is right. They can be arguments in favor of something wrong. They are, exactly like the slippery slope, or for that matter the ad hominem, the application of a heuristic, rather than a logical proof. Which is to say that, unlike logical arguments, people are free to reject them without proving themselves to be ignorant idiots.

    And, yes, democratic legitimacy does demand that, when a legislative majority passes something in the teeth of vehement public opposition, and is repudiated in the next election, that the majority that got elected opposing it really does act on what they campaigned on doing.

    I suppose democratic legitimacy isn't everything, and if a persistent majority of the public kept demanding, say, a restoration of slavery I'd be all in favor of screwing democratic legitimacy, but I'd admit that was what I opposed.

    If your position is, "Screw the people, they're getting what WE want for them, not what they want.", have the courage of it, and admit it.

  12. And, yes, democratic legitimacy does demand that, when a legislative majority passes something in the teeth of vehement public opposition, and is repudiated in the next election, that the majority that got elected opposing it really does act on what they campaigned on doing.

    Lots of assumptions here. "Vehement public opposition?" Well, loud opposition from people who have been fed a lot of lies about death panels and "socialized medicine" and the like. And from people who strangely like the featuresof the plan, but are somehow convinced by RW mendacity that when taken as a whole a bunch of stuff they like is the Devil's handiwork. And some opposition from those on the left who think the plan did not go far enough.

    But even worse is the assumption that the repudiation you speak of is strictly due to HCR. It's not. It's due to continuing economic distress. Some of us think that distress is the work of those who benefited from it.

    And could we have an end of the whole "ramming it through" nonsense? The bill passed in accordance with civics class explanations of How a Bill Becomes a Law. There were compromises, negotiations, etc., and it passed. That a large number of Republicans were prepared to vote against absolutely anything Obama proposed on any issue robs that complaint of any validity whatsoever. When Senators like Grassley refuse to support their own ideas in the face of party opposition any claims of representing the public interest go out the window.

  13. Okay, Brett, I'll accept your premise that the way the bill passed stank.

    Your assignment, then, is to explain exactly why the following GOP bills don't stink at least as much:

    (1) Medicare Part D, in which Majority Leader BugMan held voting open beyond the bill rule so he could twist enough arms to pass it.

    (2) Bush tax cuts, passed via precisely the same reconciliation rules as ACA.

    (3) The so-called PATRIOT Act, in which the debated bill was withdrawn and a substitute bill drawn up by the Bush Administration was voted on in its place.

    My point is that parliamentary maneuvering goes on in every Congress, and both sides play the game. Bitching about how something was passed is:

    (A) Whining.

    (B) Childish.

    (C) Irrelevant.

    (D) Near the height of hypocrisy.

    (E) All of the above.

  14. Brett: " They are, exactly like the slippery slope, or for that matter the ad hominem, the application of a heuristic, rather than a logical proof"

    We're not talking about logical proofs; we're talking about the real world.

    "And, yes, democratic legitimacy does demand that, when a legislative majority passes something in the teeth of vehement public opposition, and is repudiated in the next election, that the majority that got elected opposing it really does act on what they campaigned on doing."

    Which is something that the right has never done, so why should we care, and why should we consider those on the right who advocate this to be anything but dishonest people?

  15. Disagreements over health care reform policy figured prominently in the 2008 Democratic primaries, and Obama made universal health care one of his campagin promises in the general election. Congressional negotiations over the details began, if I recall correctly, in the summer of 2009, after the dust had cleared from the stimulus bill, and were held up while Blue Dogs in the Senate tried to find Republican moderates who would join with them on some kind of moderate reform that could be advertised as “bipartisan”. And they tried. And they tried. The bill that the Senate actually voted on was read for the first time in October 2009 and passed, with amendment, on December 24, 2009. After Scott Brown gave the Republicans their 41-59 Senate “majority”, House Democrats gave up trying to put their own stamp on the bill, and in March, they voted to pass it. The President signed in on March 23, 2010.

    If “this enormous bill was shoved through the legislature in a rushed and partisan fashion”, then I can’t imagine how any Congress could pass a bill in a deliberate and non-partisan fashion, ever.

  16. Damn. I was defended by Brett. Didn't mean for that to happen. Anyway Barry, I come from a part of the country where arguments from authority were used from 1607-1968 with some pretty foul consequences (they still are, and not just in the South, but that's another matter for another time). That's all. I am a working scientist and I take things on "faith" from "authorities" all the time "in the real world." But there is generally something more than the authority, which can also mean prestige, of a group behind the practical necessity to accept provisionally someone else's result at face value. That's all. I happen to think Harold is right, but having 270+ economists on his side is a weak way to make the case.

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