Must-Read: So What Did the Medicaid Expansion Actually Do?: "In 2014, only 26 states and the District of Columbia chose to implement the Patient Protection and Affordable Care Act (ACA) Medicaid expansions for low-income adults...:
Must-Read: Aaron Carroll: So What Did the Medicaid Expansion Actually Do?: "In 2014, only 26 states and the District of Columbia chose to implement the Patient Protection and Affordable Care Act (ACA) Medicaid expansions for low-income adults...
J. Bradford DeLong: The Supreme Court's RomneyCare Decision and the Future of Health Care Reform: 07/02/2012: As delivered at the U.C. Berkeley SCOTUS ACA Forum, July 2, 2012:
With respect to last Thursday: One piece of background is all-important in assessing the decision: ObamaCare is RomneyCare.
The health-care reform plan that Mitt Romney proposed when he was Governor of Massachusetts is the health-care reform plan that Barack Obama proposed.
July 02, 2016 at 07:57 AM in Economics: Health, Long Form, Moral Responsibility, Obama Administration, Political Economy, Politics, Streams: (BiWeekly) Honest Broker, Streams: (Tuesday) Hoisted from Archives, Streams: Cycle, Streams: Economics, Streams: Equitable Growth, Streams: Highlighted | Permalink | Comments (1)
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Another in my series of webloggers who I think are underappreciated--of people who, by accidents of chance and historical contingency, are just as smart (or more) and are as (or more) worth reading as I am. Richard Mayhew of Balloon Juice is doing some of the very most interesting blogging-from-the-trenches of our health care financing system.
Here's a baker's dozen of worthwhile reads:
Live from Cyberspace: Storify: ObamaCare and Employer-Sponsored Insurance: Larry Levitt and Friends...
From Last January: ObamaCare Increases the Salience of Antitrust in Health Insurance Markets from "Important" to "Essential": As the extremely-sharp Aaron Edlin has taught me, apropos of the current wave of proposed health insurance mergers--Aetna-Humana, Anthem-Cigna, and Centene-HealthNet:
The coming of ObamaCare makes any willingness on the part of antitrust authority to allow these mergers to go through extremely dangerous and destructive policy indeed.
Live from the Big Muddy: Richard Mayhew: Elections Have Consequences: Louisiana Edition: "Via the New Orleans Time Picayune. elections have consequences...
Live from La Farine: Scott Lemieux sends us to Jonathan Chait on the unprofessional hagiography the New York Times and Jennifer Steinhauer are committing for Paul Ryan:
Scott Lemieux: "Yah, okay, I'll have my girl send you over a copy, then": "Chait highlights perhaps the most ridiculous part of the NYT’s embarrassing Paul Ryan hagiography Erik highlighted earlier...
Live from La Farine: What would a HRC administration do for the health-care sector, anyway? My view is that--with the exception of implementing a public option on the exchanges, and aggressively enforcing our antitrust laws--it is not worth expending political capital here until we can see how ObamaCare turns out: we have placed a lot of bets, so let them ride until the ball settles in its slot, and then re-optimize.
But they think differently. And Larry Levitt points me to interesting and reasonable things...
Larry Levitt: "New Clinton Health ideas: Tax credits for OOP costs/premiums...
Justin Fox: Niall Ferguson and the Rage Against the Thought-Leader Machine: "Harvard historian Niall Ferguson ran into an online buzzsaw this week...
...He says the ‘liberal blogosphere’ was out to do him in, and that was part of it. But there’s something bigger at work: a groundswell of resentment for and frustration with the ‘thought leaders’ who craft our conventional wisdom, get paid big speaking fees for it, yet often behave in ways that don’t accord with this status. First Jonah Lehrer, then Fareed Zakaria, now this — and surely there will be more such brouhahas to come. It may be that this groundswell is driven entirely by frustrated would-be speechmaking thought leaders. But I think it’s more than that (then again, as a would-be speechmaking thought leader, I would).
Live from La Farine: The Economist: Birth Control and Obamacare: A Pious Hijacking at the Supreme Court: "When... dozens of Christian charities and schools say that filling out a form designed to protect them actually constitutes a mortal threat to their beliefs...
...a skilled lawyer is wise to supply the berobed ones with a conceptual crutch.... Paul Clement... twisted reality rather impressively when he said that the government’s aim was to ‘hijack’ the health plans of religious organisations in order to provide their female employees with contraceptives. But two conservative members of the court who, some thought, might join the four liberal justices in ruling against the groups, seemed rather taken with the idea.
Richard Epstein Proves Unintelligible...: I had always thought that Richard Epstein was just pulling the traditional not-very-ethical lawyer's trick of knowingly and falsely claiming that what he hoped would be law in the future had in fact been law in the past.
There is great and weighty precedent for this way of lawyering, after all.
Consider Lord Chief Justice William Draper, 1st Baron Wynford (13 December 1767 – 3 March 1845:
We [would] get rid of a great deal of what is considered law in Westminster Hall, if what Lord Coke says without authority is not law...
Now comes Scott Lemieux to say that I am wrong--that Richard Epstein has in fact drunk his own koolaid:
David Weigel: Trump and ‘universal health care': the silver bullet that never connects: "The Club for Growth was the first conservative group to strap on 'Stop Trump' spurs...
Barack Obama promised his supporters that he would run a government not for Blue States or Red States but for the United States. And to that end Obama has attempted to adopt:
Thoroughly centrist governance.
Thoroughly technocratic governance.
And yet the execrable Josh Kraushaar claims that the radical-left policies of the Kenyan Muslim Socialist have driven the Republican Party justifiably mad...
Ezra Klein delivers the proper smackdown:
Ezra Klein: Obamacare didn’t pave the way for Donald Trump. The GOP’s response to it did: "Political Twitter fell all over itself mocking this article [by Josh Kraushaar] blaming Al Franken for the rise of Donald Trump...
March 10, 2016 at 10:30 AM in Economics: Health, Information: Better Press Corps/Journamalism, Moral Responsibility, Obama Administration, Philosophy: Moral, Political Economy, Politics, Science: Climate, Storystream: Maintaining Standards in the Public Sphere, Streams: (Monday) Smackdown Watch, Streams: Cycle, Streams: Highlighted | Permalink | Comments (8)
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Over at Project Syndicate: Economics in the Age of Abundance: BERKELEY – Until very recently, the biggest economic challenge facing mankind was making sure there was enough to eat.
From immediately after the dawn of agriculture until well into the Industrial Age, by far the most common human condition was what nutritionists and public-health experts would describe as severe and damaging nutritional biomedical stress.
February 29, 2016 at 10:55 AM in Economics: Growth, Economics: Health, Economics: History, Economics: Inequality, History, Philosophy: Moral, Political Economy, Politics, Science: Cognitive, Storystream: The (Behavioral) Economics of the Future, StoryStream: The Rise of the Robots?, Storystream: Utopias, Streams: Economics, Streams: Equitable Growth, Streams: Highlighted | Permalink | Comments (5)
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Weekend Reading: Sam Richardson, Aaron Carroll, and Austin Frakt (2013): More Medicaid study power calculations (our rejected NEJM letter): "Sam Richardson, Aaron, and Austin submitted a more efficiently worded version of the following...
The Affordable Care Act Six Years After Passage: Hopes, Fears, Disappointments, Windfalls, and Realities (So Far)
The Future of Health Care Lecture Series: February 26, 2016, 5-7 PM: Thompson Courtroom, UMKC, KC MO http://mediasite.law.umkc.edu/Mediasite/Play/16b615abd5084bbea3cd1fa9d939847e1d
Live from Southeastern California: Richard Mayhew: "The active purchaser model gives consumers [in Mono, Inyo and Imperial Counties] meaningful choices...
There have been three very surprising things with respect to Obamacare implementation so far.
The first is the surge in enrollment in employer-sponsored insurance. The fear was that people and employers would find the coverage offered on the exchanges irresistible, and that there would be a great deal of disruptive churn as the exchanges started up. The penalty for large employers who did not offer health insurance was constructed to guard against this. Yet it seems to have been needless. The appearance of the exchange option appears to have led to more rather than fewer employers offering insurance.
The affordable care act six years after passage:
Hopes, Fears, Disappointment, Windfalls, and Realities (so far)
Friday, February 26, 2016 :: 5:30-7:30 PM :: Thompson Courtroom, Ground Floor University of Missouri--Kansas City School of Law :: 500 E. 52nd Street :: Kansas City, MO
Charles Gaba: Ted Cruz and the Case of the Vanishing Health Plan: "GOP Senator Ted Cruz, the guy who hates Obamacare so much he shut the entire federal government...
...down just to prevent it from being implemented... told his campaign supporters that he and his family:
- had lost their Blue Cross Blue Shield of Texas PPO insurance policy at the end of December;
- that the ACA was the ‘cause’ of their policy being cancelled;
- that he and his family are therefore no longer currently insured; and
- that the new policy which he’s (belatedly) decided to replace it with is going to cost 50 percent more than the old one[:]...
Are these the right papers for first-year Ph.D. students in Economics to read for their week spent thinking about the Malthusian Economy? If not these, what are the right papers?
Richard Mayhew: Technically true bullshit: "One of the leading lights of the conservative ‘health wonk’ community[, Scott Gotlieb,]...
...is peddling bulls--- that is technically true, if you parse it correctly, but designed to mislead anyone but a hyper technical reader. Last year open enrollment started on November 15th. The 6th week of open enrollment would have been the first week of January. This year, open enrollment started on November 1st. The 6th week of open enrollment just wrapped up.
Live from the Roasterie: Relying on the health-care market and fee-for-service Medicaid leaves enormous gaps in our ability to deliver the right kind of health services to the population. Why we have not adopted more of a public-health model--why we did not use the need for stimulus in 2008-11 to adequately provide health services on a public-health model--was and is beyond me...
Ann Marie Marciarille: Global Health Grand Challenge: Enable Self-Testing for Cervical Cancer: "Like others of you, I read about developments in global public health...
Charles Gaba: Avik Roy's latest is kind of embarrassing:
Out of all of the 2,500+ blog entries I've posted over the past 2+ years here, the one I'm most proud of was 'A Response to Avik Roy', from March 25, 2014 (written right in the thick of the crazy, frenzied final week countdown of the first ACA Open Enrollment Period). This was the period when this website was at it's very peak of traffic and I was at the very peak of my media attention. I was doing nothing but updating the site for about 16 hours per day, interrupted only by eating, sleeping and being interviewed by every outlet under the sun. Needless to say, I was frazzled, exhausted and short-tempered, and in fact I ended up falling victim to a nasty case of shingles as a result immediately after the close of the April 15th 'Overtime Period' a couple of weeks later.
Live from the South Bank of the Ohio River: Charles Gaba: Kentucky: Am I actually supposed to sympathize with Dennis Blackburn???: "Matt Bevin didn't just include generic "Obamacare suxx!!" boilerplate...
...as part of his campaign rhetoric; he made repealing Medicaid expansion (and shutting down the kynect ACA exchange) a major part of his campaign for Governor. EVERYONE in Kentucky knew this (or damned well should have known it). Yet, Mr. Blackburn voted for the guy who had explicitly promised to take away his healthcare coverage... and now he's confused and scared that Bevin might, you know, actually do what he said he was going to do...Seriously, how the hell am I supposed to respond to this guy?
Over at Equitable Growth: I have been someone who takes the long-run secular decline in prime-age male employment as a canary in the coal mine: it has seemed to me via sign that information technology which greatly reduces valuable employment of human brains as cybernetic control elements for machines poses us with significant problems that are not necessarily economic but rather in the sociology of social roles. When Case and Deaton on the decline in life expectancy among the white and middle-aged crossed my desk earlier this week, I thought that case was reinforced.
But now I find myself updating and looking at this graph: READ MOAR
Must-Read: Anne Case and Angus Deaton: Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century: "This paper documents a marked increase in the all-cause mortality of middle-aged white...
Live from KU Medical Campus: Anupam Jena: What Happens to Patients When doctors Leave Town?:
3-5 p.m., Nov. 4, Kansas University Medical School School of Nursing Auditorium. A panel comprised of KU hospital and area cardiologists including Drs. Buddhadeb Dawn, Barbara MacArthur and James Vacek will follow. View flier and RSVP."
Comment of the Day: Charles Steindel: "Well, from a slightly different but vaguely comparable position (but within the FR system)...
Eric Schlosser (2006): On Upton Sinclair: 'I Aimed For The Public's Heart, And... Hit It In The Stomach': "'The Jungle' Was A Socialist's Cry For Labor Justice....
...It Launched A Consumer Movement Instead....
Must-Read: As I have said before and will stay again, the Republican Party could be taking a serious policy victory lap right now, not just with respect to health policy--as Mitt Romney tried to do yesterday before losing his nerve and pulling back--and with respect to monetary policy. they could be pointing out right now that the most successful recovery in the North Atlantic from 2008-9 was engineered by Republican Ben Bernanke following Friedmanite countercyclical monetary policies.
Mitt Romney: [The late Staples founder Thomas Stemberg was] an extraordinarily creative and dynamic visionary.... Mr. Stemberg was one of the great business leaders...
...of our state and our nation,’ Romney said. ‘He was not only the founder, but someone who grew the company to a multi-billion dollar enterprise. He built an industry that employs thousands and thousands of people.... Without Tom pushing it, I don’t think we would have had Romneycare. Without Romneycare, I don’t think we would have Obamacare. So, without Tom a lot of people wouldn’t have health insurance...
Mind you, Romney could claim he was criticizing the late Tom Stemberg--"without Tom, a lot of people wouldn't have health insurance through RomneyCare and ObamaCare, and that would be a better world than this." But somehow I don't think Romney is going to go there.
I mean... Romney had so many opportunities over the past six years to play a constructive role... He took advantage of none of them... I... I can't even...
Come to the Medicare Part D Health Fair on Saturday, October 24!
9-Noon, Pierson Auditorium, Atterbury Student Success Center, 5000 Holmes St, Kansas City, MO 64110, 51st & Cherry
UMKC’s School of Law and School of Pharmacy [are] host[ing] a health fair aimed at making sure older adults understand their benefits and how to save money on medications.... The health fair is free and open to community members who receive, or are eligible for, Medicare Part D:
Live from UMKC: America's loonier fragments of both its left and its right agree on something that makes all of us worse off!
Ann Marie Marciarille: Important Health Message: Mumps: "What the Important Health Message doesn't say...
The remarkable thing is that the Republicans would not have had to get any concessions out of Obama in order to justly and accurately sell ObamaCare as a profoundly conservative policy initiative--as an attempt to sustain a market-oriented health-care financing system. Obama pre-conceded everything except for Medicaid-expansion block grants to the states, and there is certainly enough wiggle room in the waiver process as it has developed to claim that we effectively have that as well:
David Frum (2010): Waterloo: "Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.
...It’s hard to exaggerate the magnitude of the disaster. Conservatives may cheer themselves that they’ll compensate for today’s expected vote with a big win in the November 2010 elections. But:
Live from Crow's Coffee: A correspondent emails:
You apparently didn't arrive at the Kansas City Medicaid expansion event last night in time to hear:
(1) Cato's Michael F. Cannon denounce ObamaCare for not eliminating employer-sponsored insurance, and thus getting people the kind of insurance that vanishes when they get sick and lose their job.
(2) Cato's Michael F. Cannon denouncing Medicaid expansion for giving insurance to people even when they are not employed, and so eliminating the necessity to find and keep a job if you want health insurance.
You see what he did there? You are right about Think Tanks staffed by those more desperate to please ideologically-rigid billionaires than to actually think about the issues.
Live from the Roasterie: as I already wrote this morning, at the state level Medicaid expansion is a total no-brainer: your citizens are already paying the taxes to pay for other states Medicaid expansion, and so the choice is either (i) pay the taxes and get none of the benefits, or (ii) pay the taxes and get your share of the benefits. Option (i) makes sense only if you can somehow convince people that Medicaid spending is evil. Since the claim that Medicaid is useless was never and is not credible, that leaves doubling-down on race and class hatred--of ghetto-dwellers, of the working poor, and of doctors and hospitals that treat Medicaid patients as part of their practice and would like to be paid something for it.
And, of course, in reality it is not big-city hospitals that treat Black people that are going to be the first to close without Medicaid expansion, it's rural hospitals that treat white people:
Jon Cohn: This GOP Governor [Sam Brownback]'s Comments About the Poor Are Incredibly Revealing: "The hospital industry has been begging lawmakers to take the federal dollars...
Over at Equitable Growth: I actually made it to the second half of the Medicaid expansion in Kansas/Missouri panel last night:
Brad DeLong: Must-See: UMKC Medicaid Panel, and Think-Tanks: "Must-See: Alas! I seem to be missing the Kathleen Sibelius panel...
...on Medicaid expansion this evening at UMKC American Public Square: Dinner at the Square A Dose of Reality: A Medicaid Status Report...
Reactions: READ MOAR
Must-Read: Harold Pollack: If you want mental health services to prevent violence, Medicaid expansion is critical: "Oregon’s mass homicide sparked the usual debate about whether guns or mental health is the best focus in preventing atrocities...
Must-See: Alas! I seem to be missing the Kathleen Sibelius panel on Medicaid expansion this evening at UMKC:
American Public Square: Dinner at the Square A Dose of Reality: A Medicaid Status Report
But I do have a question that I would like to ask panelist Michael F. Cannon of the Cato Institute. I would greatly appreciate it if somebody else would ask the question--and get an answer:
Mr. Cannon: You said that:
I have counted more than a dozen predictions you have made ever since, back in 2005, Mitt Romney set us on our current health-policy path. All of yours have gone wrong. None of yours have gone right.
How has the fact that you have been so wrong about so much over the past decade changed your thinking about how health insurance markets work, and about health policy?
What has this episode taught you about your milieu--about think-tanks controlled by billionaires with strong ideological commitments, and surrounded by flatterers who assure them they are right about everything? And what has this episode taught you about yourself and your peers who draw their paychecks from such think-tanks?
Must-Read: Nicholas Bagley, Amitabh Chandra, and Austin Frakt: Correcting Signals for Innovation in Health Care: "A combination of legal rules and institutional forces pushes health plans to cover nearly every medical innovation...
Mark Kleiman: Don’t just stand there, do something! As long as there’s something useful to do: "Eugene Volokh... [is] ridiculously and disastrously wrong... [in] assum[ing], falsely...
...that just because we’re not currently doing much to stop the violence involving guns and alcohol, it must be the case that nothing useful can be done.... Cross-national statistics offer a strong hint that there’s something very wrong with policy in the United States, since no other developed country has anything like our rate of gun deaths... three times that of Finland or Switzerland... four times that of Canada... ten times that of Australia.... We might have something to learn....
October 1, 2015
The Honorable Orrin G. Hatch Chairman
Committee on Finance
United States Senate
The Honorable Paul D. Ryan Chairman
Committee on Ways and Means
U.S. House of Representatives
The Honorable Ron Wyden Ranking Member
Committee on Finance
United States Senate
The Honorable Sander M. Levin Ranking Member
Committee on Ways and Means
U.S. House of Representatives
Dear Chairman Hatch, Senator Wyden, Chairman Ryan, and Congressman Levin:
For decades economists and health policy experts of all political persuasions have agreed that the unlimited exclusion of employer-financed health insurance from income and payroll taxes is economically inefficient and regressive. The Affordable Care Act established an excise tax on high- cost health plans (the so-called ‘Cadillac tax’) to address these issues. READ MOAR
Must-Read: I have long thought that both Forbes and the Wall Street Journal have in mind as their target audiences that small segment of the human race that actually enjoys being free-riders, rather than that much larger segment of the human race that wants to engage in win-win reciprocal gift-exchange as a mode of social interaction...
Mark Kleiman: The Moral Universe of the Corporate Killers: "Daniel Fisher... writes for Forbes... hates plaintiffs’ lawyers...
Must-Read: As I say over and over again, conservatives could be taking a huge victory lap right now with the empirical policy success of the nationwide implementation of the health-care reform pioneered in Massachusetts by the 2012 right-wing standard-bearer Mitt Romney. It is an index of their extraordinary policy, rhetorical, and ideological dysfunction that they are not doing so.
Would somebody please point them a way back to fact-based reality?
Jared Bernstein**: The Affordable Care Act Is Providing Affordable Care. That’s a Big Problem for Its Opponents: "A gov’t program that, after a troubled start...
Live from La Strada: There was a time when it seemed like Nick Gillespie was--unusually for those on the right--a relatively smart person, with respect for reality.
It looks as though those days are gone.
Jon Chait reports--and, as best as I can determine he reports the arguments of John Merline and Nick Gillespie fairly, and greatly to their discredit:
Jon Chait: Obamacare Haters Freaking Out Over New Report: "John Merline of Investor’s Business Daily and Nick Gillespie of Reason insist Obama’s promise to save money for people with employer insurance has failed...
...Why? Because the nominal cost of health insurance has gone up.... Merline and Gillespie... assume that Obama was using a baseline of existing nominal prices.... [In their view] the only way Obama’s reforms could succeed is not only if the decades of medical inflation slowed their rate, but if prices actually dropped in nominal terms. Of course, Obama never actually said anything like this. Merline does not even claim he did. Instead, he insists that it kinda ‘seems’ like Obama meant this.... Oh, it 'seems' that way, huh? That's your argument? The reason it makes sense to judge Obamacare against an alternative world in which decades of medical inflation drop to zero percent a year is that it 'seems' as if he made this insanely grandiose promise? So, yes, if you assume that Obama meant an implausibly unrealistic promise that he did not actually say, then his reforms have fallen short....
The determination of Obamacare haters to claim vindication is a testament to the power of the human spirit in the face of all factual evidence. Right-wingers have every right to ideologically oppose the concept of a government program that uses regulation, taxes, and spending to provide insurance to people who can't afford it. Their unwillingness to concede that this program is working on its own terms is delusional.
While everyone interested in reality-based health-care policy is marveling in astonishment at how much cheaper than expected ObamaCare has been to implement, Merline and Gillespie are off raving in the corner.
Looking Forward to Four Years During Which Most if Not All of America's Potential for Human Progress Is Likely to Be Wasted
With each passing day Donald Trump looks more and more like Silvio Berlusconi: bunga-bunga governance, with a number of unlikely and unforeseen disasters and a major drag on the country--except in states where his policies are neutralized.
Nevertheless, remember: WE ARE WITH HER!
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