Mitt Romney on Medicare: Facts and Fictions

Mitt Romney:

“There’s only one president I know of in history that robbed Medicare, $716 billion to pay for a new risky program of his own that we call Obamacare” (PolitiFact).

The facts:

1) Under the ACA (Affordable Care Act), Medicare spending will continue to increase, only at a slower rate than it would have otherwise. “[B]efore the health law was passed, Medicare was expected to grow by 6.8 percent a year for 2010 through 2019.  With the health law, that yearly growth rate is projected to be 5.6 percent during that same time frame, according to an analysis from the Kaiser Family Foundation” (Kaiser Health News).

2) Thirty-five percent of these reductions come from the amount Medicare “reimburses hospitals and private health insurance companies.” “The health law changed how Medicare calculates what they get reimbursed for various services, slightly lowering their rates over time. Hospitals agreed to these cuts because they knew, at the same time, they would likely see an influx of paying patients with the Affordable Care Act’s insurance expansion” (WaPo) (The reason for this being “the law’s mandate for nearly all individuals to have insurance, which meant that providers and insurers would have millions of new paying patients and policyholders” [NY Times]).

3) Thirty percent of these reductions come from the amount “Medicare reimburses private, Medicare Advantage plans. That program allows seniors to join a private health insurance, with the federal government footing the bill. The whole idea of Medicare Advantage was to drive down the cost of health insurance for the elderly as private insurance companies competing for seniors’ business.” But that’s now what happened. “By 2010, the average Medicare Advantage per-patient cost was 117 percent of regular fee-for-service. The Affordable Care Act gives those private plans a haircut and tethers reimbursement levels to the quality of care administered, and patient satisfaction” (WaPo).

4) None of these reductions come from “the amount of benefits beneficiaries receive.” Moreover, the ACA adds some new benefits, including closing the ‘doughnut hole’ gap in Medicare prescription drug coverage, and new preventive services, such as an annual wellness visit with a physician” (Kaiser Health News).

5) Many analysts believe that reversing these reductions “would hasten the insolvency of Medicare by eight years—to 2016, the final year of the next presidential term, from 2024” (NY Times).

6) Additionally, reversing these reductions would “immediately add hundreds of dollars a year to out-of-pocket Medicare expenses for beneficiaries,” the reason being that “[b]eneficiaries, through their premiums and co-payments, share the cost of Medicare with the government.” So [i]f Medicare’s costs increase—for instance, by raising payments to health care providers—so, too, do beneficiaries’ contributions.” (Moreover, repealing the ACA “would eliminate expanded coverage of prescription drugs, free wellness care and preventive checkups.”) (NY Times)

                 

7) The Ryan/Romney budget calls for the same $716 billion reduction. Romney/Ryan want to put this money “toward deficit reduction while Obama [wants to spend] it on health care for poor people.” Romney/Ryan argue that, because they’re using this reduction to cut the deficit, their plan would “make future cuts to Medicare less likely.

“But Romney/Ryan also add a trillion dollars to the defense budget. And they have trillions of dollars in tax cuts they haven’t explained how they’re going to pay for. So those decisions make future cuts to Medicare more likely. Meanwhile, Obama cuts defense spending by hundreds of billions of dollars, raises about $1.5 trillion in new taxes, and puts all that money into deficit reduction. So that makes future Medicare cuts less likely. So if the argument is that Romney/Ryan protect Medicare by putting the $770 billion in cuts towards deficit reduction, Obama protects Medicare by twice as much by putting the $1.5 trillion in new tax revenues towards deficit reduction. So far as the deficit is concerned, there’s no difference between a dollar from Medicare and a dollar from taxes” (WaPo).

Lies of the Gun Lobby (part 2)

Lie #2: Concealed-carry laws reduce crime.

From the NRA:

Studying crime trends in every county in the U.S., economist John Lott and David Mustard concluded, “allowing citizens to carry concealed weapons deters violent crimes. . . . [W]hen state concealed handgun laws went into effect in a county, murders fell by 8.5 percent, and rapes and aggravated assaults fell by 5 and 7 percent.”[1]

Lott and Mustard derived their numbers using econometrics, specifically, a multiple regression model.[2] A multiple regression model is a statistical tool that, in theory at least, helps researchers determine the role that different factors play in causing an event. The reason for using such a model is obvious enough, as most events can have any number of causes. So Lott and Mustard employed a regression model in an attempt to determine the extent to which crime rates from were effected by concealed-carry laws and the extent to which they were effected by other factors. 

But there are serious problems with econometrics. As Ted Goertzel has noted, multiple regression would work “[i]f one had perfect measures of all the causal variables.” However, the fact is that “the data are never good enough. Repeated efforts to use multiple regression to achieve definitive answers to public policy questions have failed.” Goertzel notes that shortly after Lott and Mustard published their study, economists Dan Black and Daniel Nagin “published a study showing that if they changed the statistical model a little bit, or applied it to different segments of the data, Lott and Mustard’s findings disappeared.”[3]

In 2003 Yale economists Ian Ayers and John Donohue made a regression model containing seven additional years of data.[4] Their model determined that concealed-carry states actually had “higher crime rates in eight of the nine crime categories.” When they added “controls for other factors that might be including crime over this period,” they found that concealed-carry states had higher crime rates in seven of the nine categories.[5], [6]

Ayers and Donohue found that their thesis was amplified when they expressed their findings on a state-specific basis. (Lott and Mustard had expressed their findings in aggregate terms.)[7] When doing this, they found that concealed-carry laws “increased crime in substantially more jurisdictions than they decreased crime.” Breaking it down further, they found that there were “almost twice as many jurisdictions with an estimated increase in violent crime (fifteen) as those with an estimated decrease (nine)” and that there were “eight states with a statistically significant increase in murder while only four states exhibit[ed] a statistically significant decrease.” 

None of this, I should point out, necessarily means that concealed-carry laws increase crime. Although Ayers and Donohue may very well have developed a “statistically superior model,” even they concede that “better” does not always mean “good enough.”[8] One possible interpretation of their data, they write, is that, “[w]hile the best evidence suggests that [concealed-carry] laws generally tend to increase crime, there is still too much uncertainty to make strong claims about their effects.”[9]

* * * * * 

Notes

[1] NRA-ILA, “Right-to-Carry 2012,” February 28, 2012.

[2] John Lott and David Mustard, “Crime, Deterrence, and Right-to-Carry Concealed Handguns,” Journal of Legal Studies, Volume 26, Number 1, January 1997.

[3] Ted Goertzel, “Myths of Murder and Multiple Regression,” The Skeptical Inquirer, Volume 26, Issue 1, January/February 2002.

[4] Whereas the Lott-Mustard model contained data from 1977-1992, the Ayers-Donohue model added data through 1999. This inclusion is significant since 14 new jurisdictions (13 states and the city of Philadelphia) added concealed-carry laws between 1992 and 1996.

[5] Ian Ayers and John J. Donohue III, “Shooting Down the ‘More Guns, Less Crime’ Hypothesis,” Stanford Law Review, Volume 55, Number 4, April 2003.

[6] It should be noted that when Ayers and Donohue plugged data from 1977 to 1999 into the Lott-Mustard model, they found that crime was (statistically) significantly higher in two categories and lower in two categories. They proceed to explain that the Lott-Mustard model yields lower crime rates because it contains “a large number of potentially duplicative demographic variables.” Specifically, Lott-Mustard contains “thirty-six separate demographic percentages, breaking down each of three different race categories—black, white, and neither black nor white—and both sexes into six separate age categories from age ten up.” Believing that “the array is so extensive as to make multicollinearity [that is, “the multiple counting of the same information”[6a]] a serious issue,” Ayers and Donohue reduced these demographic controls to twelve (six for whites above the age of ten and six for blacks) and after doing so found that “it is hard to find any crime category that seems to have a robustly lower crime rate.”

[6a] "Multicollinearity," StockCharts.com.

[7] Ayers and Donohue write that “the dangers of estimating a single aggregated effect are particularly acute in this case because a state that adopts a shall-issue law early in the data period will contribute fully to the estimated postpassage effect, while a state that adopts near the end of the period will have little weight. Since we know that the late adopters tended to experience crime increases, the aggregated analysis will give less weight to these states in estimating the overall effects of shall-issue laws.”

[8] Another piece of evidence that the Lott-Mustard model is flawed: when Ayers and Donohue plugged 1977-1999 data into the model, they found that robbery did not decline in concealed-carry states. Because robbery is  “committed in a public place more than any other crime,”  it “should be the crime most likely to decline if the Lott and Mustard story of deterrence has any plausibility.”  Lott and Mustard agree with the general tenor of this assessment. As they write in their 1997 article: “Generally, we expect that the crimes most likely to be deterred by concealed handgun laws are those involving direct contact between the victim and the criminal, especially those occurring in a place where victims otherwise would not be allowed to carry firearms. For example, aggravated assault, murder, robbery, and rape seem most likely to fit both conditions.”  

[9] For more on this agnostic view, see Chapter Six of the National Academies’ 2004 work, Firearms and Violence: A Critical Review.

Paul Ryan, in a nutshell

1) Paul Ryan would cut taxes on the rich.

He has proposed lowering the top tax rate to 25 percent, which means that the top one percent of income-earners would pay nearly $156,000 less in taxes each year. He has also proposed completely scrapping the capital gains tax, which means that many millionaires and billionaires (people like Mitt Romney) would be paying almost nothing in taxes.[1]

2) Paul Ryan would raise taxes on the poor. 

Under Ryan’s plan, those making less than $30,000 a year would pay slightly more in taxes each year. That’s not because their rates would go up but because “the Ryan budget would get rid of tax breaks that benefit low-income Americans, including expansions of ‘the Earned Income Tax Credit, Child Tax Credit, and American Opportunity Tax Credit that were enacted in 2009,’ according to the Center on Budget and Policy Priorities.”[2]

3) Paul Ryan would slash social programs that benefit the poor.

The Center on Budget and Policy Priorities estimates that at least 62 percent of Ryan’s proposed $5.3 trillion cuts would come from programs that benefit the poor. That includes $2.4 trillion in Medicaid cuts, $134 billion in food stamp cuts, $463 billion in cuts to other mandatory programs that benefit the poor, and $291 billion in discretionary programs benefit the poor. These latter cuts would include Pell Grants and job-training programs.[3]

The New York Times emphasizes how devastating these cuts would be. The food stamp cuts alone would, for a family of four, “mean a loss of $90 worth of food a month.” Most people who receive food stamps “use them up in the first two weeks of a month, and many turn to food banks by month’s end. Cutting benefits so sharply would lead to a significant increase in hunger, particularly among children, which would quickly create dangerous ripples through the health and education systems.”[4]

Ryan’s austerity cuts are so severe that, if implemented, “by 2050, most of the federal government aside from Social Security, health care, and defense would literally cease to exist, according to figures in a Congressional Budget Office report.”[5]

4) Paul Ryan's plan would drive up healthcare costs and force many to lose their insurance.

The Congressional Budget Office has concluded that under Ryan’s proposed budget “most elderly people would pay more for their health care than they would pay under the current Medicare system.”[6] Ryan’s Medicaid cuts would force states “to drop coverage for an estimated 14 million to 28 million people.” Further, “[b]y eliminating the expansion of Medicaid in the health care law, cutting $1.6 trillion, it would leave another 17 million low- and moderate-income people uninsured.”[7]

5) Paul Ryan would increase military spending.

Although Ryan has billed himself as a fiscal conservative and although the US currently spends nearly as much on defense as the entire rest of the world combined, Ryan has called for spending an additional $200 billion on defense over the next decade.[8]

6) Paul Ryan hasn’t made it clear how he would balance the budget.

Ryan’s drastic spending cuts would be offset by the massive tax cuts he would give the rich. Therefore, although he claims that his budget plan would eliminate deficits, as Paul Krugman points out, “the alleged deficit reduction depends on the completely unsupported assertion that trillions of dollars in revenue can be found by closing tax loopholes.” Krugman continues:

And we’re talking about a lot of loophole-closing. As Howard Gleckman of the nonpartisan Tax Policy Center points out, to make his numbers work Mr. Ryan would, by 2022, have to close enough loopholes to yield an extra $700 billion in revenue every year. That’s a lot of money, even in an economy as big as ours. So which specific loopholes has Mr. Ryan, who issued a 98-page manifesto on behalf of his budget, said he would close? 

 None. Not one.[9] 

7) Paul Ryan supports US military adventurism.

As Daniel Larison writes, Ryan “has shown no inclination to dissent from his party on foreign policy issues at any time.” This means, not only supporting our many wars, but also rejecting diplomacy:

While he envisions continued increases in Pentagon spending, his budget proposals have included significant cuts to the much smaller appropriations for the State Department and foreign aid. According to Ryan's 2012 plan, diplomacy and development spending would be reduced sharply: From $47.8 billion in fiscal 2012 to $43.1 billion in fiscal 2013, $40.1 billion in fiscal 2014, $38.3 billion in fiscal 2015, and $38.1 billion in fiscal 2016. This lines up with his apparent distaste for diplomacy and his tendency to view diplomatic engagement with authoritarian states as inherently undesirable…

In late 2009, he jumped on the opportunity to attack the burgeoning — and modestly successful — improvement in relations with Russia as “appeasement,” which suggests that Ryan sees no benefit in more constructive relations with other major powers.[10]

8) Paul Ryan is largely responsible for our current national debt.

Glenn Greenwald points out that Ryan voted for “virtually every program that has piled up debt over the past decade, including the Iraq War (not just its commencement but its limitless continuation), the Wall Street bailout, Medicare Part D, Endless War in Afghanistan, and—in the midst of all of that—Bush tax cuts.”[11]

9) Paul Ryan has long opposed civil liberties.  

Again from Greenwald:

Perhaps most ludicrous of all is the notion that he’s some sort of advocate for restrained federal government power. As Antiwar.com’s John Glaser documented today, Ryan has continuously voted in favor of measures to expand all sorts of intrusive federal power, including making the PATRIOT Act permanent, enacting the Military Commissions Act to provide indefinite detention with no habeas corpus rights, implementing the Protect America Act to massively expand the U.S. Government’s power to eavesdrop on Americans without warrants, supporting a federal Constitutional amendment to deny same-sex couples the right to marry along with a law banning the ability of gay couples in D.C. to adopt children and the continuation of Don’t Ask/Don’t Tell, a Constitutional amendment to criminalize flag burning, and almost every proposed measure to restrict abortion rights.

The ACLU — which has been continuously scathing in its criticisms of President Obama’s civil liberties record — issued a report on the potential Vice Presidential nominees (including Joe Biden) entitled “A Heartbeat Away from the Presidency, Light Years from Civil Liberties,” and said yesterday that Ryan has “uniformly harmful views on five key civil liberties issues including a humane immigration policy, LGBT equality, reproductive rights, torture and indefinite detention and fair voting access” (he did, however, vote against the NDAA’s indefinite detention provisions, signed into law by President Obama at the end of 2011, as well as for a bill to include “sexual orientation” in the list of factors that cannot be legally used in job hiring). Whatever one wants to say about Ryan’s record, it is the very opposite of constraining the power of the federal government to intrude into the lives of individuals; indeed, it’s a testament to massive expansion of intrusive federal government power in almost every realm.[12]

* * * * * 

Notes 

[1] Suzy Khimm, “Ryan wants to give the wealthy even bigger tax cuts than Romney does,” Washington Post, August 11, 2012.

[2] Ibid. See also Richard Rubin, “Paul Ryan’s tax vision further-reaching than Romney’s,” Washington Post, August 13, 2012.

[3] Kelsey Merrick and Jim Horney, “Chairman Ryan Gets 62 Percent of His Huge Base Cuts from Programs for Lower-Income Americans,” Center on Budget and Policy Priorities, March 23, 2012.

[4] Editorial, “A Cruel Budget,” New York Times, March 29, 2012.

[5] Robert Greenstein, “CBO Report: Ryan Plan Specifies Spending Path That Would Nearly End Most Government Other Than Social Security, Healthcare, and Defense by 2050,” Center of Budget and Policy Priorities, April 7, 2011.

[6] Ezra Klein, “CBO looks at RyanCare,” Washington Post, April 5, 2011.

[7] Editorial, “A Cruel Budget,” New York Times, March 29, 2012.

[8] Kelsey Merrick and Jim Horney, “Chairman Ryan Gets 62 Percent of His Huge Base Cuts from Programs for Lower-Income Americans,” Center on Budget and Policy Priorities, March 23, 2012. See also Fred Kaplan, “What Does Paul Ryan Know About Foreign Policy?” Slate, August 14, 2012.

[9] Paul Krugman, “Pink Slime Economics,” New York Times, April 1, 2012. See also Robert Reich, “Ryan’s budget doesn’t add up,” Salon, August 17, 2012.

[10] Daniel Larison, “Paul Ryan’s foreign policy speeches: What they say about Mitt Romney’s running mate,” The Week, August 13, 2012.

[11] Glenn Greenwald, “The Right’s Brittle Heroes,” Salon, August 12, 2012.

[12] Ibid.

Lies of the Gun Lobby (part 1)

Lie #1: “Law-abiding citizens use guns to defend themselves against criminals as many as 2.5 million times every year—or about 6,850 times a day.”[1]

This number—continually cited by the gun lobby—comes from a telephone survey conducted in the 1990s by criminologists Gary Kleck and Marc Gertz. Kleck and Gertz simply asked respondents if they had used a gun for defensive purposes in the previous year, making no attempt to corroborate their answers.[2]

As Harvard’s David Hemenway has explained, the Kleck-Gertz survey is deeply flawed. For starters, it shares a problem with all surveys, namely, respondents often answer falsely in an attempt to make themselves look better. “Respondents substantially over-report their seat belt use, for example, and inaccurately report whether they voted. Not all people are completely truthful when reporting about such mundane details as their age, height, or weight.” Hemenway points to a 1994 survey in which six percent of respondents claimed they had “personally…been in contact with aliens from another planet.”[3]

Regarding the Kleck-Gertz survey, it seems clear that most all gun owners would feel they would be acting admirably, even heroically, for using a gun in self-defense. As Hemenway explains, “An individual who purchases a gun for self-defense and then uses it successfully to ward off a criminal is displaying the wisdom of his precautions and his capability in protecting himself, his loved ones, and his property. His action is to be commended and admired.”[4]

Many respondents might not have intentionally lied but rather saw themselves as “unconsciously improving on the truth—e.g., on situations in which they were afraid, they retrieved a gun, and nothing bad happened.”[5] Other respondents no doubt mistakenly believed they were acting defensively. In other words, although they genuinely believed they were acting defensively, bystanders would have seen things different. Hemenway describes different groups of criminal law experts who were asked to survey the descriptions of some purportedly defensive gun uses. And each group concluded that in a majority of cases the actions of the gun owners were illegal and socially undesirable.[6]

Some respondents might have answered falsely for strategic reasons. “Some respondents were undoubtedly aware of the debate over the incidence and utility of gun use in self-defense. A few might actually deliberately lie on a telephone survey to help boost the numbers for the sake of their political beliefs concerning the dangers of gun control.”[7]

So it seems clear that at least some of the survey’s respondents falsely claimed to have used a gun in self-defense. Now here’s the kicker. If even a small number of respondents answered falsely, the survey’s overall numbers would drastically change. So, for example, if just 1% of respondents answered falsely, then the rate of annual defensive guns uses would fall from 2.5 million to 613,000. If 1.3% of respondents answered falsely, then the number would fall to 76,000. Hemenway argues that this latter number more closely approximates reality, the reason being that it is close to the figure of 65,000 provided by the much more in-depth National Crime Victimization Surveys.[8], [9], [10]

At this point is must be emphasized that attempts to externally corroborate the surveys findings have failed miserably. For example, 34% of the survey’s respondents claimed that they had used their guns defensively during burglaries. If true, this would mean that guns were used defensively during 845,000 burglaries each year. But in the year of the survey, only around 400,000 burglaries occurred in which (a) the victims were home and (b) the victims didn’t remain sleeping. So, in other words, “the 2.5 million figure requires us to believe that burglary victims used their guns in self-defense more than 100 percent of the time.”[11]

The survey leads to a host of other absurd conclusions. “For example, the number of respondents who claim to have used a gun against rape and robbery attempts suggests that victims of these attempted crimes are more likely to use a gun against the offender than the attackers are to use a gun against the victim—even though the criminal chooses the time and place for the attack, most citizens do not own guns, and very few people carry guns. Similarly, the number of people who claim to use guns in self-defense and report the incident to police (64 percent in the Kleck survey) often exceeds the total number of such crimes reported to police, including all the crimes when the victim did not have a gun.”[12]

* * * * *

Notes

[1] Gun Owners of America, Gun Control Fact-Sheet 2004.

[2] Gary Kleck and Marc Gertz, “Armed Resistance to Crime: The Prevalence and Nature of
Self-Defense with a Gun,” Journal of Criminal Law and Criminality, Fall 1995, Volume 86, Issue 1.

[3] David Hemenway, “Survey Research and Self-Defense Gun Use: An Explanation of Extreme Overestimates,” Journal of Criminal Law and Criminology, Summer 1997, Volume 87, Issue 4.

[4] Ibid.

[5] Ibid.

[6] Hemenway, Private Guns, Public Health (The University of Michigan Press, Ann Arbor, 2004), 72-73.

[7] Hemenway, “Survey Research and Self-Defense Gun Use: An Explanation of Extreme Overestimates.”

[8] Ibid.

[9] For more about the math Hemenway employs, see Dave Richeson’s “The danger of false positives,” Division by Zero, October 7, 2011.

[10] Kleck and Gertz claim that the NCVS numbers are lower because their own survey “revealed at least seventeen million adults carrying guns for protection in public, only a small fraction of whom have permits allowing them to do this legally.” They further claim that these respondents would have been less willing to reveal such criminal behavior to the NCVS census workers. Hemenway’s rebuttal here seems entirely persuasive. First, he points out that the NCVS never asks respondents if their gun use was illegal. “Admitting to owning, carrying, or using a gun admits nothing about illegal behavior, just as responding that one was the driver in a car crash admits to no illegal behavior.” Second, “the NCVS responses are confidential; it would be illegal for the interviewers to provide individual information to the authorities, and there is no evidence that interviewers have ever done so.” Third, “much evidence exists that people being surveyed willingly report minor and not-so-minor criminal behavior, even behavior that has little possibility of positive social-desirability bias.” In one survey of 1,000 adult males, “64 percent of respondents effectively admitted to being unarrested felons, having engaged in such activities as grand larceny (13 percent), auto theft (26 percent), assault (49 percent), and burglary (17 percent).” Other studies have found that “well over 70 percent of adolescents aged twelve to nineteen admit to having engaged in delinquent behavior for which they could have been arrested.” Hemenway notes that “[e]ven prisoners willingly report prior illegal behavior” (Hemenway, Private Guns, Public Health, 242).

[11] Ibid., 67.

[12] Ibid., 67.