A few notes on how I voted in the 2017 general election in Ohio. Aside from the content notes below: I voted early, driving down to the County Board of Elections. It was super quick, and there were exactly zero people in line and a handful of helpful poll workers ready to assist. And, of course, I got a lovely sticker out of the deal.

State Issues

Issue 1: Against

Issue 1 is phrased in terms of protecting victims, which of course sounds positive. Who doesn’t think protecting victims is a good idea? But most of what’s in this is less about preserving rights for victims than it is about taking them away from the accused (or convicted). Due process is a critical foundational element of our justice system, and this undercuts it in significant ways. Most troubling, it makes it harder for people accused of a crime to get access to evidence that might exonerate them if the evidence involves the accuser. That’s a really big deal: if we’re going to deprive people of their liberty, we must make absolutely certain we’re doing it with sound justification. This is the main reason the ACLU is against passage of this issue, and while I don’t always agree with them, it’s a pretty good start.

Additionally, I’m not a fan of how frequently we mess with our state Constitution here in Ohio. Not that it shouldn’t happen, but the frequency bothers me (mind you, I think the U.S. Constitution would probably be a bit healthier if we were slightly more willing to amend it). I’ve got to think something is pretty compelling before it rises to the level of justifying a Constitutional amendment. This doesn’t make the cut; the best parts of it could be achieved through more conventional legislation.

The spending by the campaigns on each side of these issues is a matter of public record. Acording to Ballotpedia, on Issue 2, for example, the spending was $16,722,603.17 for and $58,263,579.79 against. That’s lopsided, but roughly 2:1 is nothing compared to what we see for Issue 1: $8,711,832.53 for and $0 against. $0. Nobody wants to appear to favor criminals over victims (ignoring, fo course, that many of the restrictions in this amendment have impact before any conviction happens). That feels like a problem to me.

The proposed amendment does have some good ideas in it; parts seem like good defense for victims without infringing on the rights of the accused. But we don’t get line-item vetos on things like this.

Issue 2: Against

This was the hardest to take a position on. I support what I believe the intent to be, but this issue takes a specific approach to trying to address that concern. That approach has some problems.

The part of this proposal that concerns me the most is that there’s good reason to believe this would result in additional restrictions on the set of drugs available to state programs. The issue proposes restrictions on state buyers, but no restrictions on sellers. If the issue passes, the state can’t buy a given drug for more than the VA pays—but that in no way means the drug maker is obligated to sell it at that price. Say the market price for a drug is $100 and the VA pays $76. The state can’t pay more than $76, but the drug maker is still free to say “Sorry, the price is $100”. This makes the drug unavailable to state programs, and doctors who’d like to prescribe it are unable to do so. In many cases, plenty of alternatives exist (our social bias against generics is really weird, but that’s a whole other thing), but it’s not hard to imagine a case where that isn’t true; that could be catastrophic for patients. More generally, I want doctors to be able to focus on what’s best for their patients, not dealing with (yet more) complicated billing issues.

Why the VA gets the sweetheart deal is a long and complicated story, but suffice it to say that Ohio’s state programs don’t exert anything near the same force as the VA, legally or market-wise, and it would be a mistake to presume that Ohio can behave similarly.

There’s also a real risk of this setting up a legal conflict between state and federal law for Medicaid. Federal Medicaid funding requires state programs to cover some set of drugs. If, under the above scenario, Ohio is unable to purchase them, federal Medicaid funding may be at risk. That’s a huge potential downside.

I tried to figure out the economic impact, but wasn’t able to really get anywhere—it would just require more research than I was prepared to do. Assuming drug companies want to keep their revenue constant, they’ll just offset the price reduction for state buyers to non-state buyers. We know (more or less) that the VA gets about a 24% discount on drugs it buys, but I’d have to know the comparative proportions of state vs. non-state purchasing to get the size of the of the increase for private buyers, and I couldn’t find that quickly. If anyone knows this (or how to find it), I’d love to hear about it. I also considered issues of price elasticity, but I think medical spending in the United States has shown itself to be at least fairly inelastic.

Where I landed on the economic issue was basically that it didn’t matter. State buying doesn’t dominate the market enough that drugs would become prohibitively expensive for private buyers, even assuming 100% revenue preservation, and, to the degrees we can reasonably anticipate here, I’m just sort of okay with some level of cost increase if it’d actually help achieve the goal.

What’s much more clear on the economic side is that this isn’t going to hurt the drug companies any. I saw a pro-2 argument saying we should “score one against Big Pharma and their massive profits” or some such nonsense. There is zero reason to believe this will do anything to reduce their profits. If we were running up against some level at which demand became more elastic, then maybe that’d be a consideration, but we’re not anywhere close to that.

Ohio’s Office of Budget and Management, which is required to issue a report on the expected economic impact of proposed changes of this type, essentially concluded that the proposed legislation had too many complexities to do that reasonably. The report is still a good read, and they do a good job explaining why they believe that, including addressing the issues with indirect economic impact like the likelihood of forced formulary changes. I recommend it if you want more detail on that aspect of things; I found the discussion on pages 12-13 particularly helpful.

Some proponents of this passage of this issue act as though the opposition is simply about people who get their meds through non-state sources greedily not wanting their costs to go up. That’s… well, just obnoxious. They’re either ignorant of the several other objections, or they’re pretending they don’t exist as a means of emotional manipulation. Either way, it’s not an objection that’s worth much attention.

Finally, the portion of the proposed law dealing with who’s responsible for costs relating to defending it just seems weird and unnecsescary. This is more of a gut feeling than a well-reasoned objection, but it feels like a method for funneling state money into the hands of a small set of lawyers. Not understanding any theoretical need for it (the state is already responsible for defending its laws), I don’t like that being in there.

I absolutely support what this Issue seems to be trying to accomplish: reducing drug costs for either the more vulnerable portions of our society or the state programs supporting them. But this method of doing so has too many risks, including risks that would fall on those same vulnerable populations, with too uncertain of an upside.

County Issues

Issue 59: For

This was the easiest issue on the ballot for me. The Port of Cleveland is a significant economic driver for the region, and our taxes have been funding it (in part) for a while now. There’s no rate increase—this is a straight-forward renewal of an existing levy.

Issue 61: For

This one was also pretty easy. The costs for bond issues are a little harder to weigh than taxes, since they are deferred. I wish I had a better sense of what bond issues were currently outstanding (that list has to exist somewhere, right?), but my sense of things is that we’re not at a significant risk of getting overwhelmed here (it’s happened in some places, but it’s fairly rare, and I haven’t seen too many going by here).

Other Stuff

Beyond that, we had a handful of not-terribly-exciting local elections: judge, city council, and board of education. Local elections are important, but, honestly, I’ve done basically no research on them; my capacity for political attention has been swamped by national issues. I feel bad about this, but it’s where I’m at. I make it a point to not vote on issues I’m not informed about, so I ended up abstaining on most of these.