Thanking Peggy Noonan August 20, 2013August 19, 2013 Peggy Noonan is — reluctantly — concerned. She doesn’t want things to be terrible for the Obama Administration (or the country), but it just feels . . . well, for example, the IRS thing evoked for her Watergate, which we should all agree would be deeply concerning (except that Watergate was ordered from the Oval office to subvert a presidential election, while the IRS snafu was Bush-appointed bureaucrats trying to cope with thousands of applications for tax-exempt status by searching on politically-charged words like Tea Party, Occupy, and Progressive). And now, for example, Obamacare. It’s not that she wants 30 million of her fellow citizens to be uninsured — obviously — or tens of millions more subject to the insecurity of “lifetime caps” and “preexisting conditions.” It’s just that, you know, she has deep-seated concerns. As expressed recently in the Wall Street Journal. Actually, Obamacare is beginning to look as though it may, for most people, be a non-event or else a pleasant surprise. (You wouldn’t think an entire political party could be vehemently united against something good, but remember the first Clinton budget? That not a single Republican voted for? That they were certain would tank the economy? And then it turned out we had the eight best years ever?) But Peggy is concerned, as amply quoted in this rebuttal from Aaron Carroll at The Incidental Economist: I know I should just stay away from the WSJ, but I can’t help myself. This time it’s a post by Peggy Noonan, “The High Cost of Obamacare“. I’m going to ignore her discussion of the rodeo clown incident and focus on her issue du jour with the Affordable Care Act: But back to health care. The piece I linked to, by Yuxing Zheng of the Oregonian, makes quick work of a complicated subject. A woman in Cornelius, Ore., takes care of her disabled 22-year-old daughter. The daughter has cerebral palsy, spina bifida and a condition called automonic dysreflexia. She requires 24-hour care. The mother provides it, receiving for this $1,400 a month. The mother fears—and is apparently right to fear—a provision of the Affordable Care Act that will, as Zheng reports, “largely prohibit guardians from serving as the paid caregiver of an adult child with developmental disabilities.” The mother is afraid this will mean foster care for her daughter, or a lengthy and costly process in which she herself will be forced to transfer legal guardianship to someone else. The provision, the paper says, will likely cause hardship for hundreds of Oregon families in which the guardian and the caregiver are the same person. Most of the time, I try to avoid anecdotes when making arguments for or against policy. Opinion writers don’t. But in this case I have to admire the chutzpah Noonan shows. She’s pulled up a mother who is getting paid – by the government – to care for her child. She gets paid $1400 a month to provide services to her daughter. Let me say that again. The government is paying this mother to care for her daughter. Do I have a problem with this? Absolutely not. I doubt many supporters of the ACA do. But CMS does. Why? They’re afraid of fraud: The new federal provision aims to resolve a conflict of interest that arises when the guardian who helps develop an individual service plan hires herself or himself as the paid caregiver, which could lead to financial fraud. Oregon has allowed guardians to be paid caregivers for more than 10 years under various federal waivers, and a state official says she can’t recall a case where that arrangement was problematic. CMS is more cautious than Oregon. They are enforcing federal guidelines about conflicts of interest. Now this will create legitimate problems for some families in Oregon, especially single parent families, who have been paid to serve as caregivers for their adult children with profound disabilities. I sympathize with every single one of them. So do lawmakers in Oregon, who are actively trying to fix the regulations. But let’s take a breather. Let me propose a thought experiment for you. Can you imagine if, as part of the Affordable Care Act, President Obama had proposed a new program to pay parents to stay at home and care for their children? Can you imagine the outrage that type of welfare would have sparked? I bet Peggy Noonan would have had a coronary. But in this universe, suddenly she’s championing this program. Let me propose another. Can you imagine if President Obama had proposed to eliminate this fraud prevention provision, and then the media had uncovered someone who was abusing it to collect a paycheck and stay at home with their child? Can you imagine the outrage? I bet Peggy Noonan would have screamed that all of Obamacare should be scrapped over this abuse. But in this universe, fraud prevention is harming families. So be it. But it’s telling where Noonan got her anecdote. It wasn’t from among the 560,000 people in Oregon who were uninsured in 2011 and will likely benefit from the ACA. It wasn’t from the 237,000 people in Oregon who are expected to buy a guarantee- issue and community-rated policy (many with subsidies!) on the exchange. It wasn’t from the 222,700 people in Oregon who will be newly eligible for Medicaid under the expansion. It wasn’t even from the 14,300 people in Oregon who are currently eligible for Medicaid but not getting it for some reason. No, Noonan tells a story that she picked from the 455 families in Oregon who are going to need a legislative fix in order to keep getting paid to be caregivers for their adult disabled children. I bet they get that fix. Do you think she’ll talk about that legislative triumph if it occurs? She ends with four specific points, which I feel compelled to answer: First, no mother or child should be put in this position by a government ostensibly trying to improve their lives. I agree. So will she support legislation to make it easier for parents to choose to dedicate more time to their children instead of working? Let’s wait and see. Second, everyone in America knows health care is a complicated and complex subject, that a national bill will have 10 million moving parts, and that when a government far away—that would be Washington, D.C.—decides to take greater control of the nation’s health care it will likely get many, maybe a majority, of the moving parts wrong. Again, the anecdote is telling. She didn’t choose from the majority, or even the many. She went after a specific minority where things might go wrong instead of talking about the many, many things that might go right. Third, because health-care legislation is so complex, it is almost impossible for people to understand it, to get their arms around what may be a given bill’s inadequacies and structural flaws. Stories of those inadequacies and flaws dribble out day by day, in stories like this one. They produce a large negative blur, and a feeling of public anxiety: What will we find out tomorrow? Is she serious? She’s bemoaning the dribble of bad news stories – like the one she is writing right now – and how they make people afraid! Again – you have to respect the chutzpah. Fourth, when a thousand things have to be changed about a law to make it workable, some politician is going to stand up and say: “This was a noble effort in the right direction but let’s do the right thing and simplify everything, with a transparent and understandable plan: single payer.” If a politician does, I think we’ll have pieces like Peggy Noonan’s to thank.