The Talker of the Town

tillyOnce upon a time, the New Yorker took special pride in its famously scrupulous fact-checking department. Nowadays, they’ve apparently stopped caring whether the pieces they publish are even remotely plausible, let alone true.

Thus, writing about the Affordable Care Act in the current issue, Jeffrey Toobin is able to report that “it’s clear that the law is helping a lot of Americans” because, among other things, “more than a hundred million people have received preventive-care services, like mammograms and flu shots, at no cost!!!!!!!!!!!!!!!!!!!!!!!!!!!” (Emphasis added.)

Now surely nobody at the New Yorker, right down to the greenest intern, can possibly believe that it is possible to provide a mammogram or a flu shot at no cost. The statement is so ridiculous that one has to believe either that it was intended as some sort of parody (a reading which the context does not support) or that Toobin meant to say something entirely different. But what?

Maybe he meant to say something like “a hundred million Americans have managed to get roughly a hundred million other Americans to pay for their preventive-care services”. But this seems to be an implausible reading, because it’s part of a laundry list of things that are supposed to be self-evidently good about the health care law, and there’s nothing self-evidently good about transferring a cost from person A to person B.

Now I am committed to the view that we should read each other charitably whenever possible, but in this case I can’t seem to come up with any plausible candidate for a charitable reading — let alone a plausible explanation of how this got past an editor.

It’s true, at least, that a law that takes money from a hundred million Americans and gives it to a hundred million others can accurately be described as “helping a lot of Americans”, but of course it can just as accurately be described as “hurting a lot of Americans”. Presumably there was some intent behind the choice of one locution over the other. (And anyway, it’s still not clear the statement is true, if by and large the people who are receiving these treatments and the people who are paying for other people’s treatments are by and large the same people.)

So: Did Toobin mean that this particular income transfer from hundreds of millions of unidentified persons B to hundreds of millions of unidentified persons A is a self-evidently good thing? Surely he can’t mean to say “It’s always good for Bob to pay Alice’s bills” without telling us anything about who Bob and Alice are. Indeed, in this case, it wouldn’t be unreasonable for us to guess that the recipients are, on average, better off than the billpayers — it is, after all, not implausible, that those who have their acts sufficiently together to schedule and show up for a mammogram are, by and large, those who have their acts sufficiently together to show up for work and establish bank accounts.

But beyond that, and more fundamentally, even if Toobin knows something he’s not telling us about who’s paying and who’s receiving, and even if, in light of that information, he thinks this income transfer is desirable, and even if he feels confident that, if only he had shared that information, we’d agree with him, and even if he believes we trust him enough that he doesn’t actually have to share the information in order for us to nod our heads and say “Well, if Toobin’s for it then so am I” — even if you grant all of that, a pure income transfer cannot be a significant benefit of the health care law, because a health care law is an extraordinarily indirect and clumsy way to transfer income. If Jeffrey Toobin really wants to move vast amounts of money around from one large group of Americans to another, I’m sure he can write an interesting article about that — but it’s got nothing to do with health care policy.

There are, of course, reasonable arguments in favor of the Affordable Care Act, at least in its broad outlines. (There are also plenty of reasonable arguments against it). But those arguments are off topic here, because Toobin wasn’t appealing to them.

So what on earth did he mean? Anyone?

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38 Responses to “The Talker of the Town”


  1. 1 1 Lawrence Kesteloot

    This “playing dumb” isn’t doing you any favors. I love this blog, and I learn a lot from it, but I’m tired of this tone of voice. You know very well what they thought, and what they meant, and how they were wrong, so just quote it and point out their error. That’s what I’m here for.

  2. 2 2 Phil

    He meant, “100 million people can’t afford preventive-care services, and now they get them because rich people are paying for them.”

    Or, “100 million people either are too dumb to realize they should be spending their own money on preventive-care services, but now that they can get those services are zero marginal cost to themselves, they’re opting to get them, so the law is helping them overcome their own stupidity.”

    Probably, a combination of the two, is what he means.

  3. 3 3 Martin Gale

    This is run-of-the-mill pre-Bastiat thinking, as people do have a tendency to look only at the seen (someone gets health services and does not pay) and not the unseen (someone must be paying for it).

    The reason this passes editing (and the reason people do take econ classes) is that general economic education is stuck at this pathetic level.

    I do agree with Lawrence Kesteloot that as someone who teaches Price theory, you must have encountered that so many times that you must recognize it by now. Hence you know full well that Toobin does not have any high level meaning beyond this superficial account. You may wish that editors have columns that touch on economics proof-read by people with basic econ training, but you can’t start assuming it.

  4. 4 4 Bennett Haselton

    Just because someone “has their act sufficiently together to show up for work and establish bank accounts” doesn’t mean they can afford a preventive procedure that costs at least a few hundred dollars, so I think it’s reasonable to assume that the payments are being transferred from the better-off to the worse-off.

  5. 5 5 William

    Lawrence,

    The point of writing the post in this tone is to show that it is difficult to come up with a complete model of the world in which the statement “100 million received preventative services for free” is the self-evidently good thing Toobin seems to believe it is.

    We can be certain that Toobin knows those services have to come from somewhere, so unless he specifies exactly where he believes them to be coming from, it is genuinely hard to show why he is wrong.

    Maybe you want to assume we know “what they thought, and what they meant,” by saying that Toobin just wasn’t thinking about the fact that the services have to come from somewhere. That’s one possibility. But there are others, and it is useful to think about whether any of them make sense in context.

  6. 6 6 Ron

    It’s standard U.S. advertising hyperbole. It just needs
    translation. “Free” means “at no extra cost” or “included”.
    Similarly, “at no cost” means “at no extra cost” or
    “included”. If they’re paying X for health insurance, then getting
    a flu shot “at no cost” means “with no copay” – i.e.: included in
    the premium.

  7. 7 7 Neil

    You can read this sentence as economic ignorance or, more simply and more charitably, the sentence completes with an implied prepositional phrase “to them.”

  8. 8 8 khodge

    RE: Kesteloot @1
    I, at first, thought what you thought, i.e. it was clear what Toobin was saying; however, as Steve has done so frequently, and I do so carelessly, he is showing there are MANY assumptions that Toobin is making, far beyond the rather simplistic 100kk Americans received care and it was because of the ACA. Re-read the post and see if you actually had already identified each of the assumptions that were enumerated.

  9. 9 9 Steve Landsburg

    Ron: I think there is ample evidence that Jeffrey Toobin is too intelligent to imagine that it is possible to provide a flu shot at no extra cost.

  10. 10 10 Yancey Ward

    Toobin just flat out lied.

  11. 11 11 Roger

    Steve, you are being pig-headed. There are 2 obvious interpretations.

    (1) Toobin merely omitted the implied phrase “to the patient”. It is like saying “Google offere Gmail at no cost.” Yes, it obviously costs money to run the service, but the end user does not pay directly out of pocket.

    (2) Toobin subscribes to a theory that preventive care saves money throughout the system. That is, the modest cost of a flu shot will be more than made up for by saved money on flu treatements, fewer sick days, etc.

  12. 12 12 Matt S.

    Toobin wrote “at no cost”. It would be more accurate to have written “at no price”.

    The Google example is a good one: there is a cost to using Google’s search engine (privacy, seeing ads), but there is no price. Similarly, there is a cost to providing preventative health care services, but (now) no price.

  13. 13 13 suckmydictum

    @11

    “but the end user does not pay directly out of pocket.”

    I’m not sure what “end user” means in your context.

    Advertisers who fund gmail use do so voluntarily with a transparent profit motive (they do so directly out of pocket, btw). No one has legislated that someone has to fund gmail.

    Conversely, when my taxes or premiums increase to fund flu shots, I also pay directly out of pocket, but since I am legally obliged to participate, I am as much an “end user” as the beneficiary of the flu shot is. This seems to be Landsburg’s central point.

  14. 14 14 nobody.really

    I had the same reaction as Roger @ 11.

    Toobin merely omitted the implied phrase “to the patient”. It is like saying “Google offere Gmail at no cost.” Yes, it obviously costs money to run the service, but the end user does not pay directly out of pocket.

    I’m not sure what “end user” means in your context.

    He’s referring to the patient, and the person using Gmail.

    I’ll echo the opinion voiced throughout these comments: Feigned incomprehension is not an especially persuasive, or clever, way to present an argument.

  15. 15 15 TeeJaw

    Perhaps only Toobin knows what he means by anything he says, but we know what he actually did say and what it means to say what he said.

    He said, “at no cost.” In the context in which he said those words they mean “at a cost that was of no concern to the patient because it was borne by other nameless and faceless persons of which the patient has not a care in the world.”

  16. 16 16 iceman

    Neither is offering empirical arguments without empirical support, if Roger’s #2 were Toobin’s basis. E.g. all we can say for sure about something like flu shots is that 100 million Americans got a pain in the arm (or some other appendage) for their trouble. The number that were “helped” is the fraction who would’ve otherwise actually developed the flu. I’ve heard that only in a few areas is preventive care actually cost-effective (if that’s the claimed purpose).

  17. 17 17 Bob Thompson

    I think it’s fair enough to present an implied completion to Toobin’s ‘at no cost’ statement, but Steve’s point has more substance and that is that Toobin’s statement is so narrow and incomplete that it is laughable, impliedly deceitful, and the type of statement expected from a politician on the campaign trail. I think I know how Toobin thinks, (that it is a good thing to take property from some and give it to others when one thinks that action provides a good result), but my question, and maybe Steve’s, is why people think like Toobin, i.e. what is the underlying rational process in a political system that recognizes property rights of individuals. At least, if Toobin were to acknowledge that a similar unknown number of individuals were hurt or hindered by the Affordable Care Act, one could recognize that he is favoring a socialistic act.

    By the way, on ‘Meet the Press’ this past Sunday, David Gregory said something similar in a discussion of costs, something to the effect that some health care cost were less because of the subsidies provided by government. I rolled my eyes and thought to myself, ‘where does he think government gets the money to subsidize those costs?’.

  18. 18 18 Capt. J Parker

    “At no cost, at no cost” – You keep using those words but, I do not think it means what you think it means.

  19. 19 19 suckmydictum

    @14

    “He’s referring to the patient, and the person using Gmail.”

    Yes, and for the reasons I outlined, I contend the analogy is weak.

  20. 20 20 Capt. J Parker

    @Roger 11,
    For mammograms there is an ongoing controversy a about overdiagnosis and there is a recent study indicating that they do not result in fewer cancer deaths. http://articles.latimes.com/2014/feb/11/science/la-sci-breast-cancer-mammography-20140212 I would think this would mean there is a possible question about there cost effectiveness. For flu shots I would have guessed their cost effectiveness was a sure bet. It turns out that people were actually willing to do public health studies of that very question and it is NOT always the case that the answer is flu shots are cost effective. http://www.who.int/influenza_vaccines_plan/resources/lee.pdf

  21. 21 21 Cos

    I agree with the first comment – this really reads as you playing dumb. It’s totally accepted usage in English to say “at no cost” and mean “they didn’t have to pay directly to get the service.” In other words, these individual people who got these services did not spend any money that they would otherwise have kept if they hadn’t gotten these services. Which is clearly what he meant.

  22. 22 22 Steve Landsburg

    Cos: Did you read the rest of the post? I considered this explanation and rejected it, on the grounds that Toobin has included this on his list of “obviously good” things about the health care law, whereas having a bill transferred from Alice to Bob is not obviously good.

    If you think I’ve got that wrong, you might consider explaining why. But simply pretending it’s not there does not constitute a refutation.

  23. 23 23 Roger

    The supporters of Obamacare usually argue that preventive care is a money saver. They even argue that birth control pills should be free because they prevent more expensive pregnancies.

    Unfortunately a lot of preventive care is not cost-effective, as some comments have noted. I doubt that Toobin has looked into the matter. He may have been fooled by a common misconception.

  24. 24 24 Keshav Srinivasan

    Steve, Toobin isn’t doing an efficiency analysis. He’s not taking a position on whether the transfer is a good thing from a social welfare point of view, he’s just saying that it’s a good thing for the people who are getting the free treatment (where again free means free for them). He’s trying to determine how many beneficiaries there are of Obamacare.

  25. 25 25 Capt. J Parker

    Keshav 24,
    I think you are making Landsberg’s point. Landsberg says: “Did Toobin mean that this particular income transfer from hundreds of millions of unidentified persons B to hundreds of millions of unidentified persons A is a self-evidently good thing?” I believe you are saying Toobin only means it’s self-evidently a good thing for the beneficiaries who are many. But, if Toobin is doing what you say, he is making a naive argument in favor of ACA (see Martin Gale 3)that might escape notice in a middle-school debate club contest but should not show up in New Yorker magazine.

  26. 26 26 nobody.really

    On context:

    1. Jeffery Toobin is not the New Yorker’s resident economist. He’s a legal/legislative commentator.

    2. Toobin writes plenty of long-form stuff, including books. Landsburg has not expressed fault with those. Instead, Landsburg takes issue with a sentence in a 1000-ish word column occupying the “Talk of the Town” space.

    3. Here is the first paragraph of Toobin’s column – including the sentence Landsburg finds objectionable:

    The Affordable Care Act, President Obama’s perpetually beleaguered health-care initiative, received a jolt of good news last week. As the first deadline for coverage in 2014 drew near, the Administration announced that the number of people who signed up had passed six million. That’s short of the original goal of seven million, owing largely to the disastrous launch of the federal Web site last fall. The methods for tallying beneficiaries, like everything else about the law, are being disputed, and regional disparities remain severe. Still, it’s clear that the law is helping a lot of Americans. Three million young people remain on their parents’ health-care plans; more than eight million uninsured people are eligible for Medicaid; and, according to the Department of Health and Human Services, more than a hundred million people have received preventive-care services, like mammograms and flu shots, at no cost.

    4. This is how Toobin introduces what he purports to be a thorough discussion of a cost-benefit analysis of the ACA, incorporating considerations of not merely the effect of the law’s policies on aggregate health care spending, but on social outcomes generally.

    No, of course not.

    Rather, this is how Toobin introduces a cursory discussion comparing the politics and law of launching the ACA to the politics and law of launching Medicare and Medicaid in 1965. Medicare, providing health insurance for Americans over 65, enjoyed immediate public support. But Medicaid, providing health insurance for the poor, was vulnerable in its infancy and rejected in 24 states. Yet Toobin suggests that once Medicaid began extending benefits to a large number of people, it became a stable part of the social safety net.

    Much of the column recounts challenges to the ACA. But Toobin argues that the ACA, like Medicaid before it, has now become a stable part of the social safety net because it is now providing benefits to a large number of people.

    5. I do not understand the comments of Landsburg at others to either embrace or contest Toobin’s thesis.

    Rather, I understand them to complain that Toobin has failed to focus on their own thesis – specifically, a thesis about the ACA’s costs. I find this to be a perfectly accurate criticism. I’m sure we could compile a long list of things Toobin failed to address within the scope of that column. But they are beside the point of Toobin’s thesis.

    Now, to be fair, Toobin’s style suggests he approves of social safety net programs; the column seems to contain a needless note of boosterism. And the phrase “at no cost,” while idiomatic, is counterproductive because it conveys a false idea. I suspect this objection, combined with Toobin’s benign view of social safety net programs in general, are what triggered Landsburg’s objections.

    6. In sum, there are many things that can be said about the costs and benefits of the ACA – and may people have said them. There may be many things that can be said about the merits of Toobin’s thesis about the ACA having generated benefits for a lot of people, and thus having a achieved a measure of stability – but so far, we really haven’t addressed that thesis.

  27. 27 27 maurile

    I think I can speak for Mr. Toobin here because, although I did not read his article, I did skim the parts that were quoted in Prof. Landsburg’s blog post, and it’s quite evident what he meant.

    “No cost” means “no marginal cost to themselves,” and the reason it’s a good thing has nothing to do with transfer payments, but with the fact that Mr. Toobin thinks that increased mammograms and flu shots promote health and (despite the cost) total utility.

    Basically, what Phil said.

  28. 28 28 Wonks Anonymous

    It’s plausible he believes flu shots are a public good, so the marginal consumer should have them subsidized. That’s different from just “Alice should transfer money to Bob”.

  29. 29 29 Capt. J Parker

    @ nobody.really 24,
    1)If ACA benefited some but did so at significant costs to others and those others were not significantly better of to begin with than those who benefited from ACA would it make sense to claim ACA is stable? Wouldn’t (and Shouldn’t) ACA be changed or repealed under those circumstances? Your summary makes Landsberg’s point. If Toobins thesis is (quoting you) “about ACA having bdnefited at lot of people and

  30. 30 30 Capt. J Parker

    @ nobody.really 26
    You said ” There may be many things that can be said about the merits of Toobin’s thesis about the ACA having generated benefits for a lot of people, and thus having a achieved a measure of stability –but so far, we really haven’t addressed that thesis.” I’ll address it. It is a bogus thesis since it ignores the costs and it ignores who bears those costs. Do you really intend to argue that net social welfare should be ignored in the discussion of a major policy. If not, do you alternatively intend to agrue net social welfare is increased as long as someone benefits and the policy becomes stable – costs and those bearing them can be ignored?

  31. 31 31 Capt. J Parker

    Please disregard post 29. Post 30 is the response I’d like to direct to nobody.really. Interface is a little rough on Kindle Fire

  32. 32 32 nobody.really

    ”There may be many things that can be said about the merits of Toobin’s thesis about the ACA having generated benefits for a lot of people, and thus having a achieved a measure of stability –but so far, we really haven’t addressed that thesis.” I’ll address it. It is a bogus thesis since it ignores the costs and it ignores who bears those costs. Do you really intend to argue that net social welfare should be ignored in the discussion of a major policy?

    No.

    If not, do you alternatively intend to argue net social welfare is increased as long as someone benefits and the policy becomes stable…?

    No.

    If not, do you alternatively intend to argue [that] costs and those bearing them can be ignored?

    Yes. Specifically, costs and those bearing them can be ignored by Toobin when he’s making an argument about politics, not economics.

    In short, I don’t understand Toobin to be making an argument about the economic benefits f the ACA. Rather, I understand Toobin to be making an argument about the prospect of the law enduring politically. And the argument he’s making is just a slightly more documented version of the argument that many opponents of the ACA – especially libertarian-leaning opponents – have been making all along: Whether the law is good or bad, once it acquires a large constituency it will become politically difficult to fix. I would have expected this insight to be more readily accepted by most people at this blog. No, it’s not a happy view, but it’s a rather conventional one.

    For what it’s worth, I don’t know how accurate Toobin’s assessment is. I think Toobin’s analysis applies to policies such as Social Security and Medicare, which have a large and politically active constituency. Who really benefits from the ACA? Most Americans already had health insurance. I suspect the law benefits the poor, plus the insurance/health care industry. Poor people are famously ineffective at defending their interests politically. (Look at Food Stamps and unemployment insurance. Food Stamps only endures because it was tied to the Farm Bill; once financial pressure was put on the Farm Bill, Republicans were more than willing to throw Food Stamps overboard. And unemployment insurance is always blinking in and out, notwithstanding the fact that we have unprecedented levels of long-term unemployment.) So the question arises, does the ACA provide enough benefits to the health care industry to get them to defend it politically? Time will tell.

    Bottom line: The economic benefits of legislation are not closely tied to its political fortunes; otherwise, we wouldn’t offer tax breaks for Arabian stallions. Toobin’s analysis addresses the ACA’s political fortunes. Think the ACA is costly and inefficient? Fine – but unless you’re arguing that the cost will cause the US government to collapse, arguments about cost and inefficiency are really not relevant to Toobin’s thesis.

  33. 33 33 Capt. J Parker

    @ nobody.really 32,
    Well, there is a lot to what you say in bold. However, accounting for net social welfare but ignoing costs is oxymoronic IMHO and I’d argue Toobin thinks so too hence his purile attemp to equate freebies for some with an obviously good thing. Then there is also Gruber, grand pubah of Obomney care who said (see March 12 Bob murpby blog) MIT’s Jonathan Gruber: ”The advocates who say [ObamaCare] is working great are saying too much. And the opponents who say it’s working terribly are saying too much. We simply do not know how its working yet,” Gruber said, adding that details would start to emerge over the next several months…”We just need to be patient and let it work out. And you know what, if it turns out to be bad, I have every faith in the American system that they’ll get rid of it.”

  34. 34 34 Floccina

    The most charitable meaning is:

    100 million American got preventive care with no direct costs to themselves, and this is a good thing because if they had to pay for it directly they may not have gotten it and the preventive care will pay off for some of them in a big way so they will be much better off and since it is plausible that it might save us all money in the long run we are all better off for it.

  35. 35 35 Roger

    You guys are overthinking this. Toobin is a lightweight. He probably has an employer-paid health insurance policy where he used to pay a $10 co-pay for flu shots, and now he pays $0. To him, that means free. He may not be thinking any deeper than that.

  36. 36 36 iceman

    Since I think we’re supposed to be more charitable than #35:
    nobody.really’s analysis may be correct (Toobin’s point is political not economic), but in that case the “at no cost” comment is still irrelevant at best. The example of Social Security is that in order to make people feel invested in a program you just need to take enough $ from them that they want to get at least some of it back, i.e. even if they’re net losers.

    And again if Toobin’s point is that various examples of preventive care are public goods / cost-effective, this would be expressing a “belief” over an an entirely empirical – and in this case readily testable – matter, on which we might ask for a little context.

  37. 37 37 Renato

    Of course the imaging company performing the mammograms and the drug company producing the flu shot are completely neutral on this issue.

    It may (flu shot) or may not (mammograms in low risk women under 50) be cost effective to have these preventative services but the decision making becomes distorted when these services are subsidized (no copays, etc.) in favor of other potential cost effective preventative services like running shoes or salad bars.

  38. 38 38 Harlequin

    You ask too many questions (for Toobin). He wasn’t writing for people like you, i.e., those who think, reason, and ask disturbing questions. He was writing for the “masses,” those zillions of gullible folks who DO NOT question the agenda of Big Brother.

    You see, Jeffrey Toobin does not believe in the autonomy of the individual person, or human action. He only believes in GOVERNMENT action. Also, he only thinks in terms of “groups.” This is because he is an unrepentant member of an elite which thinks and plans collectively. Thus, he can only generalize about human beings and considers them faceless and interchangeable parts of a collective.

    Propaganda like this is calculated to appeal to the least intelligent, the softest brains out there. It appeals to the emotions, not to reason. It is meant to denigrate free market capitalism by stirring up envy in poor, mediocre people against wealthy and accomplished ones. It represents the vulgarization and decivilization of our culture through mass democracy and destructive government interventionism in the economy for “our own good.”

    Robbing Peter to pay Paul is what government is all about, is it not? You can’t run Big Government or a Police State without these involuntary transfers of wealth, so…..there you have it.

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