Pre-Election Day Predictions for VA, NJ, and NY-23

Last week I offered my assessment of the key 2009 elections one week out, I return as promised to offer predictions for tomorrow.

Virginia - It's all over but the counting. Tomorrow will be a big night for the GOP as Republican Bob McDonnell reclaims the governorship and the GOP wins all other statewide races (Lt. Governor and Attorney General). I expect the results to be quite lopsided with McDonnell winning by at least 10 points. This will have a down ballot effect and the GOP will probably add about 7 seats to its majority in the legislature. This means that the GOP will have total control of VA during the redistricting that will take place after the 2010 census.

New Jersey - Jersey continues to be a tough race to call, Christie's once commanding lead has gone, but Corzine's numbers have never improved and his approval rating is among the lowest for any governor. Independent candidate Chris Daggett appears to be fading and the late trend suggests a return for Christie. A new Public Policy Polling survey shows Christie up by 6 points. I stand by my prediction that Christie will win by about 2 percentage points, driven mostly by his continued lead among independents.

New York 23 - The most fascinating race of the year. The liberal Republican candidate Dede Scozzafava suspended her campaign on Saturday as it became clear that she could not win. Then on Sunday she endorsed the Democrats Bill Owens. Conservative Party nominee Doug Hoffman appears to have the momentum in the race, but it is unclear what impact Scozzafava's endorsement will have.  This race is getting attention with many seeing it as a microcosm of a coming civil war within the GOP between the conservative base and more moderate voices - but Scozzafava's decision to endorse the Democrat lends credibility to the many Republicans who felt that she simply was not a Republican. Embracing moderates is one thing, by most accounts Scozzafava was not a moderate Republican so much as she was a liberal to moderate Democrat running on the Republican ticket. I expect Hoffman to win by about 5 points.

So yes, I see a tremendous night for Republicans. Democrats will argue that Virginia and New Jersey were decided based on state issues and have nothing to do with the President or his agenda (even as Obama has now declared the NJ race as essential to his agenda). In NY-23 Democrats will argue that it shows that the GOP has no place for moderate or independent voices (a tough argument to make given that moderate and independent voters will be crucial to GOP wins in VA and NJ). If Hoffman wins by more than 5 points (assuming that he wins) in a district carried by President Obama the argument about GOP extremism will be very hard to make.

If there is a GOP sweep tomorrow expect this to seriously undermine key legislative initiatives such as health reform and cap and trade as moderate Democrats become increasingly concerned about 2010.

Stay tuned...

Update: Will Virginia and New Jersey be Canaries in the 2010 Coal Mine?

Back in early September I urged you to watch the off year elections in VA and NJ very closely, arguing that two GOP victories would indicate a high level of GOP intensity, Independent willingness to vote GOP, and, most deadly, Democratic apathy. Today marks the one week countdown to Election Day 2009 and I think that it is a good time to revisit the states. There appears to be nothing left to do in VA other than ask how large Republican Bob McDonnell's margin of victory will be.  The three most recent polls show McDonnell crushing Democrat Creigh Deeds by 11, 15, and 17 points. Despite (or perhaps because of) high profile help from Bill Clinton, and other leading Democrats, Deeds is in fee-fall. Now comes word that President Obama will campaign for Deeds today (October 27). This could prove to be embarrassing for the president if Deeds goes on to lose by double digits in a state that is central to Obama's reelection plans. As if the news in VA could not get worse for Democrats, Republicans appear poised to win (reclaim) all statewide posts.

New Jersey is bit more complicated. Back in September Republican Chris Christie appeared to be heading for certain victory over the Democrat John Corzine, the state's unpopular incumbent governor. But things began to shift during late September and early October as Independent candidate Chris Daggett gained traction after Corzine launched a scathing barrage of negative ads seeking to discredit Christie - even making multiple (not so veiled) references to Christie's weight problem. As a result, Christie began to lose support as Daggett's support began to rise. Interestingly, Corzine's support has budged little - stuck around 40%. Normally that would be a death sentence for an incumbent, but the presence of a strong third-party candidate meant that Corzine could win with only 40% support. Although Christie's once clear lead over Corzine has evaporated the most recent polls from NJ suggest that Christie has rebounded (slightly) and that Daggett is losing steam. The last three polls have Christie ahead by 2, 3, and 4 points - certainly too close for comfort, but all show a trend back toward Christie, away from Daggett, and absolutely no momentum for Corzine - despite high profile visits from the President and Vice President and reports that Corzine is outspending Christie by a 3 to 1 margin.

At this point - one week out - I predict with confidence that Republicans will sweep VA setting the stage for a tough battle for Obama in 2012. I also predict that Chris Christie will win a very narrow victory in reliably blue NJ (probably a 2% margin). Democrats will argue that the races have no national implications, Republicans will claim that they represent a repudiation of the Democratic agenda - the truth will be somewhere in between. Expect a clear Republican victory in both states to embolden the party and to further depress Democratic enthusiasm and momentum. A clear Republican victroy in both states will also cause many a Blue Dog Democrat to reconsider their support for a range of issues from health reform to cap and trade as the 2010 midterms begin to take center stage.

The wild card to watch next week is the special election in New York's 23rd Congressional District. A reliably Republican distrcit where the GOP nominated a liberal Republican, Dede Scozzafava, to run against Democrat Bill Owens. Not pleased with the Scozzafava choice the Conservative Party nominated conservative Republican Doug Hoffman. Initial fears within the GOP were that Scozzafava and Hoffman would split the GOP vote and deliver the district to Owens - but two recent polls (each with small sample sizes) show that Hoffman has pulled into the lead. Though the polls showing a Hoffman lead were partisan polls with small sample sizes a review of polls taken since late September show a clear trend in the race. Democrat Owens has been stuck at about 30%, Scozzafava has been losing support, and Hoffman has been rising. If Hoffman wins this race it will show that conservative voters - many of whom sat out the 2008 election - are re-energized. In mid-term and off-year elections few things matter more than an energized base.

See you next Tuesday night...

The Need for Real Health Care Reform

The current reform proposals being considered in the House and the Senate will not solve the systemic problems in the American health care system - in fact they will likely make the problems worse. The current reform proposals maintain our fragmented system and will even add to the fragmentation.... read the rest at the FreeStater Blog.

Gay Marriage: It's a Simple Question of Equality

Perhaps it is appropriate that an 86 year old WWII vet reminds us that equality has always been the American ideal.... in a simple way this is a man standing up for his son, in more profound way it is veteran demanding that his nation live up up to the ideals for he so many have fought and died - freedom, liberty, equality.

Deciphering Public Opinion on Health Care Reform

Trying to understand what all of these health reform polls mean? I argue that Democrats are correct when they say that the public supports a public option, and Republicans are correct when they say that the public opposes the health reform proposals currently being considered in Congress... How can both be true? Check out the FreeStater Blog to find out.

Rationing Health Care: What We Already Do, Done Better

It's a dirty word that no politician dares to utter, but any discussion of health reform, and of cost containment, demands that we talk about rationing. As stated by ethicist Peter Singer argued this past summer "The debate over health reform in the United States should start from the premise that some form of health care rationing is both inescapable and desireable. Then we can ask, What is the best way to do it?" My goal with this post is to better explain rationing, show why it need not be a dirty word, and show how we already engage in health care rationing everyday.

Let's start our discussion in Oregon circa 1987. Oregon's Medicaid program only covered adults with earnings below 60% of the federal poverty level (FPL), but the state wanted to find a way to cover everyone up to 100% FPL - but the state could not spend any additional money. A state commission was formed to determine how to achieve this goal. The commission looked at all services provided by Medicaid and divided them into approximately 700 treatment groups. The groups were then ranked based on medical and cost effectiveness. Treatments that scored well were given a low number, treatments that fared poorly were assigned a high number. Figure 1 shows the treatment groups on the horizontal and the income level of the population on the vertical - the grey area represents treatments that are not covered.

Oregon was providing access to all 700 treatment groups to every Medicaid recipient with earnings below 60% FPL, but nothing was covered for those earning 60% FPL or above (the grey area in figure 1). The Oregon legislature decided that in order to provide health insurance to everyone below 100% FPL they would stop covering the least effective (high numbers in figure 1) treatments. The state stopped covering treatment categories that fell above treatment group 550 (figure 2). This saved enough money that the state was able to provide coverage for treatment groups 1 to 550 for everyone earning below 100% FPL. It was explicit rationing of care, those services deemed to be the least medically or cost effective were dropped, but the state was able to increase the number of people covered by Medicaid by 50%.

So what are the national implications of all of this? Imagine that the 700 treatment groups identified in Oregon were extrapolated to the entire country. Currently, those with good insurance, in Medicare, in Medicaid (other than in Oregon), and those who are wealthy have access to all 700 treatment groups. But access to those treatment groups declines as income (and likely the quality or presence of insurance) drops. Figure 3 shows how health care is already rationed in the United States everyday. The poorest Americans, those lacking adequate health care, have limited access to any of the 700 treatment groups. As income rises so does access to care. This is rationing, but unlike the Oregon experiment, this rationing is driven entirely by one's ability to pay for care. Rather than rationing to ensure that everyone has equal access to a set standard of care it is rationing that provides some unfettered access to care while others can access very little. And it's all based on ability to pay, not on need.

The solution, based on the Oregon example, would be to limit access to the least effective services, and with the money saved, extend equal coverage to everyone (figure 4). In Oregon, the state was dealing with a finite pool of funds for the Medicaid program. Nationally, we would be dealing with a finite pool of funds drawn from the population via taxes to fund universal health care. The inclusion of the entire population in the purchasing pool would likely mean fewer excluded treatments.

In a prior post I argued that the only way to effectively control costs was to implement a single-payer model of health care delivery in the United States. I cited the McKinsey Global Institute's finding that America spends 30% more on health care than we should - largely due to overuse of services. Ending the overuse of services, and therefore saving substantial sums of money from our $2.5 trillion health care economy can only be achieved effectively via single-payer. Achieving those cost savings would require empowering some governmental agency to review service use and determine which treatments are most and least effective, and therefore which services to be covered with our finite resources. It would be explicit rationing, but unlike our current approach to rationing health care, it would be based on providing equal access to the same standard of care – regardless of income.

Special credit goes to Donald Barr and his terrific book “Introduction to U.S. Health Policy” for key information and concepts used to inform this post.

Public Support for Health Reform: Increasing or Collapsing or Neither?

Interesting data from Pollster.com on health reform - seems clear that support for health reform has not been on the rise as some have suggested.

According to Pew, Obama's approval is down and the public clearly opposes Congressional health reform proposals - and this is from a sample with only 23% Republicans. Gallup puts it at 51% in favor to 41% oppose, the AP puts it at 40% to 40%, and Quinnipiac has it 47% opposed and 40% in favor.

Taken together, the numbers suggest that the public is either opposed or indifferent. The best that could be said by reform proponents is that opposition has leveled off and stopped rising, while support has stopped falling and leveled off.

Public support needs to be higher to bring Republicans on board - even with the urging of former party leaders like Bob Dole.