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COLUMNISTS
TODAY'S STORIES
23.09.2008
Factchecking the Factcheckers on Obama's New Ad

Factcheck.org has decided Barack Obama’s new argument about John McCain’s health care plan is misleading. National Review’s Ramesh Ponnuru agrees. And, since I made a similar argument about McCain's health plan here on Sunday, Ramesh criticizes me, too.

I respect both Factcheck and Ramesh, who is one of my favorite conservative writers. Here’s why I think they are mostly (though not completely) wrong.

At the center of this controversy is a quote, from a recent magazine article, in which McCain says the following:

Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.

After Paul Krugman blogged about that quote on Friday, numerous bloggers and eventually Obama himself seized on it as proof that McCain would bring deregulatory chaos to health care. “That’s right,” Obama said in North Carolina, “John McCain says he wants to do for health care what Washington has done for banking.” Later it appeared in an Obama ad, which is what drew Factcheck's scrutiny.

The Obama line works because of the timing: It’s happening in the middle of a major financial crisis brought on, in part, by lax regulation. But the problem with this argument, according to both Factcheck and Ramesh, is that McCain’s reference to “banking” had nothing whatsoever to do with Wall Street.

Instead, McCain was apparently referring specifically to regulations that allowed interstate banking--an innovation that made possible the proliferation of automatic teller machines (ATMs) we all now enjoy. “Does Obama believe that restrictions on interstate branch banking should be brought back?,” Ramesh asks. “Does Cohn?”

Well, no. (Actually, I’m not sure--I really don’t know much about that law. But I like my ATM card, so I’ll take it on faith that it’s been a beneficial reform.) Factcheck and Ramesh have a point here: The word “banking” in the McCain quote does not, strictly speaking, seem to mean what Obama has implied.

But the precise definition of "banking" here is really of minor substantive consequence. The larger issue raised by Obama (and me) is whether McCain’s health care plan would treat health care with the same kind of deregulatory zeal that’s proven so disastrous on Wall Street. And here, I continue to think, Obama is absolutely, positively correct.

McCain, like most conservatives, believes that a major problem with health care today is the excessive regulation of health plans by the states. That’s why he wants to allow people to purchase individual insurance policies across state lines--so that they can circumvent those regulations.

This isn’t some secret agenda. It’s one the McCain's campaign's talking points. Back in April, when McCain introduced his health care plan during a major speech in Florida, he called the cross-state purchasing of insurance “a crucial step in ridding the market of both needless and costly regulations.”

As the quote implies, McCain thinks that reducing regulation will unleash greater competition and, ultimately, do more to reduce the cost of medical care than more liberal reforms. Ramesh, unless I’m mistaken, believes the same thing.

Obama disagrees. He thinks the case for regulation is often stronger than conservatives concede, as the crisis on Wall Street shows. That's the argument he's making about McCain's health plan, both in speeches and in the new ad. As I wrote on Sunday, that seems fair to me.

Update: More on this controversy from NPR's Julie Rovner. Pay particular attention to the quotes from state insurance commisisoners in Iowa and Oklahoma, who worry how a proposal like McCain's might affect their constituents.

--Jonathan Cohn

Posted: Tuesday, September 23, 2008 10:27 AM with 11 comment(s)

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Andrew Davis said:

One of the fundamental problems of globalization is that knowledge is lost and uncertainty increases with distance.  Local banks serving local markets know their customers and the local economy and are therefore better able to understand the risks involved in making local loans.  Loans held in aggregate by mulitnational firms cary more risk because the firm simply cannot know as much about the ability of the borrower to replay.

If health care insurance was commodified as were mortgages, the same problem would ensue.  Insurance is about risk management, and the risk would go up with distance.

September 23, 2008 10:56 AM

tomhilliard said:

I agree with Cohn on the substance, but having nothing useful to add. So I'll point out two stylistic things I noticed: 1) respect for people who disagree and/or criticize the author; and 2) willingness to concede a point. This kind of grown-up behavior is sadly lacking on the blogosphere, even among some writers I take the time to read. More like this, please.

September 23, 2008 11:08 AM

Crock1701 said:

I also notice that twice now (first with Social Security, now this) Factcheck.org misses the forest for the trees by focusing on minutia (Bush said no one from before 1950 would be affected, McCain meant ATMs) rather than the larger common sense facts (SocSec is a Pay as you go system, so removing current payroll taxes would affect those getting benefits now, no matter when born; Interstate Health Care would be race to the bottom deregulation).  Suffice to say, I'm becoming less and less impressed with them.

September 23, 2008 11:28 AM

blackton said:

ATM's? Now McCain is taking credit for that too? First it was the blackberry, now it is the ATM. A huge difference between interstate banking is 1. banks are FDIC insured. If I open a bank in Washington and move to Florida (where there are no local branches) I can still access my money (but due to ATM fees would likely choose another bank in the area, who wouldn't? But if I buy insurance from Idaho and live in Georgia and it has no branch offices in my state doing any kind of routine business will be cumbersome. I bought a new car through Toyota financial and a month later I still have not gotten my payment book or contract and my first payment is due in a few weeks, It is not like I can pop down to the local Toyota financial office so I must endure hours on a 1-800 number and promises that it will be mailed any day now. And this is Toyota, not some third rate idaho insurance company looking for excuses not to make good on policy payments.

Do the insurance companies in Idaho have any understanding of hospital pricing policy in New York, can they themselves navigate billing problems in New York from Idaho?

John McCain's health care plan is deranged- no other word for it. In no other major industrialized nation does anything like it exist where everyone (except Seniors or gov't employees) are expected to treat buying health insurance like buying a toaster on ebay.

Mexico, yes Mexico! has a more intelligently designed health care system. I can take my IMSS card anywhere in the country and it will be honored. Partly because of my guaranteed health care and lack in the US I can't even move back to the US to find work, I simply can't risk it.

September 23, 2008 11:38 AM

icarusr said:

"Partly because of my guaranteed health care and lack in the US I can't even move back to the US to find work, I simply can't risk it."

Blackie, move to Canada.

Switzerland has a market-based, but mandated health insurance system.  You can buy health insurance anywhere in Europe, actually.  But then, the insurance industry is heavily regulated all over the EU and Switzerland, so the risk of fraud and taking advantage of patients is relatively low. (In any event, if regulators fail to implement EU directives, local governments are on the hook for damages arising out of the failure, so there is comprehensive discipline.)

In short, market-based solutions are good, as long as there are proper regulatory mechanisms in place to address potential - indeed, inevitable - market failure.

The bigger problem is, of course, something that Bismarck identified a hundred years ago and - given that he and McCain are contemporaries - I wonder why McCain does not understand.  "Public health" is not simply a question of personal choice or commodifying a service; it is a question of national security.  In WWI, German soldiers were far better fed and better educated than the average Tommy or Poilu; this is one reason for the initial successes of the Bosch against the allies.  Bismarck realised that you cannot have sick worker and sick soldiers producing for the war machine or fighting for the Fatherland, hence the comprehensive social programmes he put in place to ensure cradle to grave (well, premature grave, at any rate) health and education protection.  Funny that a hundred years later, McCain is regurgitating the same tired lines of British conservatives in the 19th century that resulted in the 5'5' scurvy-ridden Tommies of WWI ...

September 23, 2008 12:07 PM

Andrya0 said:

There's a big problem with the incentives of the state insurance commissioners.  If my California health insurer denies me coverage when I get sick, I can appeal to the California insurance commissioner, who has an incentive to help me, since she/he is accountable to the voters of California.  If my insurance company relocates (in a race to the bottom) to Mississippi, the Mississippi state insurance commissioner isn't likely to be interested in my problem.

September 23, 2008 12:09 PM

wildboy said:

To quote John McCain, "He chooses his words very carefully."  In all seriousness, who in his campaign was responsible for going ahead and publishing an article favorably comparing banking and health care deregulation (regardless of the specifics) AT THIS TIME??  Even assuming the magazine was already put together by September 15, he surely had time to fix things before the Freddie/Fannie bailout.  The level of ineptitude in his campaign is truly astounding.

September 23, 2008 12:38 PM

bdgreen said:

This article is absolutely spot-on. McCain is now a frantic supporter of health insurance deregulation -- of deregulation of all kinds -- and I cannot see that any of his former efforts to the contrary were successful, or anything but stalking horses for his ambition. Any more than his lauded campaign finance reforms bore any fruit other than good press for John McCain. (McCain is gleefully spending unlimited campaign money through his party during this election, and expresses not a hint of remorse. Tell me another !@#& fairy tale about McCain-Feingold again!)

Right now -- sadly and pathetically -- the only real reforms are occurring on the state level. Ask Massachusetts whether it wants to give up its regulatory control over health plans sold in Massachusetts, for instance. Shared risk pools don't work when insurers can cherry-pick their customers. And the only efforts to keep insurers from cherry-picking are happening on the state level. It's no shock that Republicans want to shut them down.

This is not only the thousandth Horrible No Good Really Bad Idea McCain is pushing, but it is so shockingly tone-deaf -- like Bush pursuing his hopeless crusade to privatize Social Security long past the point where it was a laughingstock. This further reinforces the impression that McCain is just another befuddled emperor-in-waiting who will "spend his political capital" on ludicrous personal obsessions from day one.

And, yes, for what it's worth, the collapse of state banking regulation had bad results, too. Predatory lenders now universally locate in regulatory wastelands (hi, Delaware!) so that they can fleece consumers without the barest hint of restraint. Needless to say, this degree of deregulation was hardly necessary to allow ATM cards to function across state lines.

September 23, 2008 12:50 PM

adsprung said:

While the Riegel-Neal Act that enabled interstate banking in 1994 did not gut consumer protections, subsequent Bush Administration initiatives in 2003 and 2004 did. Factcheck simply took Holtz-Eakin's word for what McCain "meant" in his article -- as if McCain meant anything in particular beyond "I'm always for less regulation" and "let's empower health insurers to bypass tough state insurance mandates."  Leaving aside the foot-fault of substituting "Wall Street regulation" for "banking regulation," Obam'as ad is fair -- and dead-on. More at xpostfactoid.blogspot.com/.../factcheckorg-carries-water-for-mccain.html

September 23, 2008 12:59 PM

desertdog said:

Excellent point, Andrew Davis.  

The further removed the customer is from the provider/insurer/broker/lender, the more likely it is that they have no knowledge of local conditions or stake in the customer's outcomes.

When my mortgage got sold for the fourth or fifth time to a bank in ??, they have no clue what my local property values or selling environment is like.  Nor do they understand or CARE about my personal financial situation.  No knowledge means huge mistakes can, and obviously, will be made.

Health insurance sold across state lines in a de-regulated environment would work exactly the same way, with even worse consequences. In the first case, it's only my money.  In the second, it's my life.

September 24, 2008 2:35 PM

jackstpaul said:

I had this

www.huffingtonpost.com/.../mccains-health-care-plan_b_128890.html

published yeterday about McCain's health platform re: de-regulation and the Obama and Fact check claims.

I agree with Jonathan Cohn about the accuracy issue.

September 25, 2008 7:55 AM