Live from The Roasterie: We see what Paul Gigot, Rupert Murdoch, and the rest of the Wall Street Journal are doing here:
They are saying to Anthony Kennedy and John Roberts: "You aren't going to let yourself be persuaded by some women, are you?"
Live from The Roasterie: We see what Paul Gigot, Rupert Murdoch, and the rest of the Wall Street Journal are doing here:
They are saying to Anthony Kennedy and John Roberts: "You aren't going to let yourself be persuaded by some women, are you?"
Over at Equitable Growth: Last week I noted my wife Ann Marie's:
...a poster child for the clear articulation and active supervision standards required to determine whether an anticompetitive policy is indeed the policy of a given state, and entitled to immunity…. North Carolina’s Dental Board functioned more as a trade association with super powers granted to it by the state–apparently with an open-ended portfolio of responsibilities relating to dentistry in the state…. The dissent argues the delegation was valid.... READ MOAR
Over at Equitable Growth: Ezra Klein, one of the viri illustres making us hope that the press corps over the next generation will actually be a net plus to the nation (cough, Judy Miller of the New York Times; cough, Fred Hiatt of the Washington Post) has a good post that, I think, misses one important point:
Live from the Roasterie: With respect to King v. Burwell, can anybody tell me the statistics on what the ultimate Supreme Court vote is when the Supreme Court did not have to take jurisdiction, but rather took it because four of the justices explicitly decided to?
Over at Equitable Growth: For the first time, we have a clue as to what Republican plans are for what to do with respect to health policy in the event of an anti-government Supreme Court decision in King v. Burwell. And the Republican plan of Nebraska Senator Ben Sasse is the same as the Democratic plan--override the Supreme Court. The difference is that the Democratic override would be permanent, while Sass is only proposing a temporary override. For now. READ MOAR
We can no longer say "the structure of the King plaintiffs argument..." for it is not clear that there are any King vs. Burwell plaintiffs, or that if there are any King plaintiffs they agree with any of the arguments that the lawyers from Jones, Day are making on their behalf. This is a huge black eye for Jones, Day, and is certainly making everyone reconsider what they thought they knew about the quality of their work. But I digress...
Scott Lemieux warms up by observing:
- The fact that former Cato interns wanted no part of the troofer lawsuit;
- The title implying that Politico hacked into Cannon’s email, rather than the massively more likely possibility that the email was provided by one of the recipients, or *Cannon complaining about the Cato institute being described as ‘right-leaning.’
Before taking the stage for the main event:
Have I mentioned that no matter what else Jonathan Chait writes, we love him for things like this?
...to more than 11 million, and the conservative response to the law’s demonstrable success at carrying out its goals has been fascinating to behold. Measured by volume, the right-wing backlash has diminished severely, as great roaring waves of furious anger have given way to irregular ripples of discontent. But measured by its content, very little has changed.... To take a typical example, here is Stephen Moore, "chief economist at the Heritage Foundation, making his case", such as it is, that Obamacare has failed to meet its cost targets. Perhaps the most revealing aspect of Moore’s column is the fact that, five years after its passage, the chief economist of the most influential conservative think tank in the United States lacks even a passing familiarity with it....
...hosted by the National Institute for Health Care Management Foundation, where he cited reporting by former NPR reporter Julie Rovner that, he claims, supports his understanding of the law. Cannon’s interpretation of Rovner’s reporting, however, did not sit well with the moderator of the debate, former NPR reporter Julie Rovner. After Cannon attempted to use Rovner’s reporting in support of his argument, Rovner, who now reports on health policy for Kaiser Health News, produced a copy of the article Cannon cited and read it aloud to him in order to prove that it does not actually support his claims...
And, rather than apologizing or retracting, Michael Cannon writes:
Note: neither @jrovner, nor @nicholas_bagley, nor @imillhiser, nor @MyConstitution has accepted my challenge...
Maybe @imillhiser or @MyConstitution will lend space to @jrovner, @nicholas_bagley, me to discuss @RepLloydDoggett letter & JR's reporting?
Notice what he did there? He cited Julie Rovner's story as an authority. When she pointed out to him that the story did not say what he had cited it to say, he shifted ground to not citing but challenging her reporting.
I must say, the lies here are just too thick for me...
Over at Equitable Growth: Can someone point me to something Stuart Butler has written in the past three years that has turned out to be correct?
I mean, it seems to be blinkered, partisan, wrong--and obviously wrong at the time, both in its analysis of the political forces and of the policy substance.
Am I wrong?
Take a look:
At least when the Cravath partners went hunting for named plaintiffs for anti-New Deal cases back in the 1930s, they found plaintiffs like the Schechters who had in fact been injured by New Deal policies.
Jones, Day is going to be spending a long time trying to live this down, I must say...
I am left with a lot of questions: If Senator Richard Burr does not see a path to passing an ObamaCare replacement this year, why make a splash with a proposal that is not a bill rather than simply scheduling hearings?... And why does Peter Sullivan of The Hill not tell his readers that BHU is a reboot of BCH–if, that is, he has the slightest desire at all to be in the trusted-information-intermediary business?... Why does it please Burr to have The Hill’s readers thinking that this is something that Burr has come up with in the last two months, rather than a line of approach that he has been thinking bout, tweaking, and trying to get right for years?....
I actually think that the motives of Burr et al. are eminently comprehensible... Randy Barnett explained it for us:
With or without bipartisanship, however, Republicans need to have a well-vetted replacement in the pipeline. To make a favorable ruling in King more likely, the legislative wheels must be visibly in motion by the time of oral arguments in March.
If it’s entirely clear that siding with the ACA troofers will throw most of the country’s health care insurance markets into chaos will Congress does nothing, it might give Roberts and Kennedy pause. It might not--I can very much see Roberts writing a hilariously disingenuous conclusion asserting that his troofer holding will modestly allow Congress to clarify its intent--but as Barnett’s concerns indicate, it might.... Congressional Republicans putting on a kabuki make[s] it easier for... Kennedy and Roberts to lie to themselves a la Michael Strain.... Republican legislators showing up at press conferences... after having visited Kinko’s with copies of earlier terrible proposals may be good enough for the swing votes on the court....
As Ed Kilgore pointed out at the time Barnett’s proposals can only be called black comedy gold.... Even for an ACA troofer, declaring that ‘such a bill is very likely to be bipartisan’ is shameless. It’s the lying to yourself/lying to others question again--in Barnett’s case, I’m pretty confident that it’s the latter.
Over at Equitable Growth: I am left with a lot of questions: If Senator Richard Burr does not see a path to passing an ObamaCare replacement this year, why make a splash with a proposal that is not a bill rather than simply scheduling hearings? If Richard Burr thinks that the Burr-Coburn-Hatch proposal from last year was unfairly rejected by his Republican colleagues and that they should take another look at it, why put Burr-Hatch-Upton forward as if it were brand-new--as if it were not a reboot of last year's Burr-Coburn-Hatch? And why does Peter Sullivan of The Hill not tell his readers that BHU is a reboot of BCH--if, that is, he has the slightest desire at all to be in the trusted-information-intermediary business? And even if he doesn't want to be in the trusted-information-intermediary business, why does it please Burr to have The Hill's readers thinking that this is something that Burr has come up with in the last two months, rather than a line of approach that he has been thinking bout, tweaking, and trying to get right for years? READ MOAR
Over at Equitable Growth: I think, yet again, that this New York Times story on the Burr-Hatch-Upton ObamaCare replacement proposal would have been much better if it had been assigned to David Leonhard's The Upshot rather than to the New York Times's national news desk. The indispensable link that should be in Robert Pear's story but isn't is here. And it should have been compared to last year's equivalent
Robert Pear's article:
Hey! All of y'all who are not subscribing to the Financial Times, you really should be.
...I checked into the hotel, a nice place, but my room, upon entering, was a dank meat locker. I looked around for the thermostat but I couldn’t find one, and I went to open the windows and they were sealed shut. So I asked the front desk how to make the room slightly less frozen and was told: ‘We keep all rooms at a consistent temperature. Guests seem to prefer it this way.’ I figured, what can possibly go wrong sleeping a few nights in a room like this?
By my third morning I have a cough: hack-hack. The next morning, my last at the hotel, the hack-hack has turned into a deep cough-cough. As the week progressed elsewhere in Georgia, the cough turned into bronchitis, and I could feel foamy bubbles percolating in my lungs when I lay down to sleep. Yes, there’s nothing sexier than wheezing, a bodily function seemingly designed to remind us all that death lurks around every corner. Finally, I dragged myself to a local medical clinic, and this is when things got really American.
Comment on: Amanda Kowalski: The Early Impact of the Affordable Care Act:
This very interesting paper by Amanda Kowalski tells me that costs have risen by a lot in many places. I am surprised
That suggests to me that many of the previously uninsured were not low-value consumers, the kind who would not demand much health care, as we saw in the case in Massachusetts.
That foregone consumer surplus caused by not insuring the uninsured earlier has thus turned out to be very much bigger in the pre-ACA regime than I had thought. And so the potential positive social welfare effects of the ACA are significantly greater than I had believed likely.
Moreover, the paper seems to me to imply that the division of the surplus from subsidies between insurance companies on the one hand and consumers on the other is very different between the states that have aggressively pursued ACA enforcement and those that have not. In the passive and nonimplementing states--the nullification states--insurance companies appear to have grabbed a greater amount of the surplus. I wonder if that might explain some of the absence of a strong insurance lobby in nullification states for more aggressive implementation? Non-implementation means that insurance companies forego some of the potential subsidy pool. But it also means that the pressures in the ACA that would increase market competition are also largely absent.
A Question: For us economists, intensive economic growth is the rate in percent per year at which the real cost of obtaining the currently-produced bundle of marketed goods and services decline. what I am hearing from Erik is that, in his view, that is missing much if not most of the action: that what we really ought to be doing is measuring the rate at which the real cost of staying on the same utility surface is declining. And that these two are very different right now.
There is no sound macroeconomic case for a rapid reduction in the share of debt to GDP at a time when interest rates are still at or near their lower bound and there are risks to the recovery. So, if the macroeconomic argument for deficit reduction is unsound, there has to be another motive.... [And] why on earth has Ed Balls come to accept the austerity case?... Just think if Clement Attlee’s government at the end of the second world war had decided that the first priority was to reduce the debts built up during the war.... READ MOAR
and tell me what is going on here. Anyone have any plausible answers for me?
The lack of any public or even private willingness to mark one's beliefs to market is amazing. As is the inexorable and irresistible desire to call the pitch a strike before the pitcher has even walked to the mound.
It's not as though either Cochrane or Epstein has the confidence that would have been created by a lifetime of calling the balls and strikes more accurately than anyone else that might have motivated such hubris.
Nor do either of them have any standing other than that that comes from a perception of being smart. One would think one would guard that by trying really hard not to say things that are really stupid. And one would think that they would have matched outcomes to their ex ante subjective distributions enough in their lives to correct for the possession-of-knowledge syndrome fact that your subjective probability distributions tend to be much too tight when you know something about a subject.
Or perhaps I have gotten it wrong?
Perhaps both Cochrane and Epstein believe that their real standing comes from being not smart but both (a) really clever and (b) really ideological--that their standing comes from their auditors' confidence that their arguments and positions (c) won't necessarily be correct but (d) will conform to their expected ideology and (e) will not be prima facie, ludicrously, and easily and immediately seen to be wrong.
The problem is that the (e) part no longer seems to hold...
And I get that for Epstein the root animus is the status insult at being put into the same category as females--that community rating is a mighty infringement on his liberty because it forces him to buy gynecological care as part of his essential benefits package. But the root emotional animus has to be translated into arguments and thoughts somehow, doesn't it?
Over at Equitable Growth: I read Reihan Salam over at Slate.
My first, minor, thought is that the Slate editors seriously fell down on their job in failing to demand even a modicum of intellectual consistency here. Let me endorse Brian Buetler:
...to obscure and delay transfers so that budget analysts wouldn’t treat the law as they might a single-payer program where... everything coming in is a tax, and everything going out is an expenditure.... The right’s memory has grown conveniently spotty.... In 2011, in a different context, Salam mocked the kind of scolding he’s now directing at Obama. ‘Ah, he made the program marginally less politically poisonous, which will make it harder for us to demonize him. Now let’s attack him for hypocrisy!’ he wrote, paraphrasing critics. The policy architect in that instance was Paul Ryan, who proposed phasing out the existing Medicare program, but only after 10 years, and only for future retirees. At the time, Salam didn’t believe his opponents’ rhetorical strategy had much merit. ‘I mean, I get it,’ he added. ‘But also: let’s move on'...
My second, big, thought is that there are no live policy ideas--that the Republicans are now the captives of the nihilists they have turned their activist base into, and that their only strategy now is to hope that somehow, some way, ObamaCare can be made to collapse. READ MOAR
That the Cadillac Tax was an unnecessarily complex and inverted long-run Rube Goldberg way of accomplishing McCain's 2008 goal of eliminating the tax preference for employer sponsored coverage.
That CBO's distinction between mandates and taxes was unhelpful in either building a well-working system or understanding how it would work.
That the gamble that cost-control measures would be effective in the long-run was a gamble.
And the very sharp Jon Cohn agrees with me: READ MOAR
Back in 2011 when Jon Gruber was writing Health Care Reform: The Graphic Novel he assumed that subsidies were available to all purchasing on any exchange--whether a state-initiated §1311 exchange, a joint exchange, or a federally-initiated §1321 exchange did not matter: families will pay no more than 9.5% of their income to purchase health insurance--not families living in states that have established §1311 exchanges: families full stop:
...During my travels, I often heard, ‘We know what the rest of the country thinks of us.’ It would become a point of pride, then, that in 2007, Mississippi was leading a race it wanted to win. That fall, a full year before Obama’s election to the White House put national health care reform on the agenda, the governor, Haley Barbour, called up the newly elected state insurance commissioner Mike Chaney, a Vietnam veteran from Vicksburg. The two Republicans had been friends since college; Chaney had been the rush chairman for Sigma Alpha Epsilon at Mississippi State University when Barbour pledged the fraternity. Now, the governor had an assignment for his old friend.
Need to know about Medicare Part D & in Kansas City?
As best as I can estimate, ObamaCare's Medicaid expansion right now has a benefit-cost ratio of 4-to-1. And, of course, its benefit-cost ratio for the power brokers of Missouri is ∞-to-1: they are not paying for it.
"Awesome in its evilness" was how Jon Gruber described ObamaCare nullification. How can anybody sane not agree?
...would fail and that it would result in worse rather than better health care. But after a rough start, the ACA is largely meeting its implementation goals. It is significantly reducing the number of the uninsured. And whereas health outcomes are improving in Massachusetts, the first adopter of ACA-like reform, Varney’s article suggests that in Mississippi the health care system is showing signs of collapse. It’s hard to look at Mississippi and conclude conservatives were right, for the ACA was hardly given a chance in that state, as Varney details.... Part of what has happened to Mississippi is likely the result of specific policy choices by elected officials. But a lot of it was baked into a terrible history. Nevertheless, Governor Kasich’s question is, we believe, on point:
‘The opposition to [Obamacare] was really either political or ideological,’ Ohio Gov. John Kasich (R) told the Associated Press earlier this month. ‘I don’t think that holds water against real flesh and blood, and real improvements in people’s lives.’
Principles matter, but how do you weigh principles that dictate opposition to access to basic health insurance against the costs borne by Mississippi’s rural poor?...
In the other 31 states, Obamacare is doing fine and is likely to keep doing fine in spite of whatever the Supreme Court rules in King. In those 31 states, they either have state exchanges that are unaffected by King or will quickly add a state wrapper to their federal exchange: no state politicians of any party are going to accept ObamaCare money to cover their Medicaid poor and deny exchange subsidies to their middle class.
But the politicians and Obamacare are now in much bigger trouble in the nineteen states with one-third of the population: Alabama, Alaska, Florida, Georgia, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, Wyoming. If King brings down the hammer, will the politicians of the nineteen nullification states throw away the $40 billion in exchange subsidies to their middle-class citizens that are currently anticipated for 2016? That seems a very heavy political lift.
And I very much doubt that the King appellants will be able to round up their fifth vote: the Supreme Court would have to overrule long lines of statutory interpretation and break a great deal of administrative law in pieces to get there.
They might: this is a very partisan Supreme Court that follows the election returns.
But I think Roberts wishes to have a place in history different from that of MacReynolds.
the Supreme Court just agreed to review King v. Burwell, the Fourth Circuit’s decision upholding an IRS rule extending tax credits to federally established exchanges.... At least four justices... voted to take the case... The justices’ votes on whether to grant the case are decent proxies for how they’ll decide the case. The justices who agree with King wouldn’t vote to grant.... The justices who disagree with King... there are at least four such justices.... That means that either Chief Justice Roberts or Justice Kennedy will again hold the key vote. None of this bodes well for the government. That’s not to say the government can’t win. It might. As I’ve said many times, the statutory arguments cut in its favor. But the Court’s decision to grant King substantially increases the odds that the government will lose this case. The states that refused to set up their own exchange need to start thinking—-now—-about what to do if the Court releases a decision in June 2015 withdrawing tax credits from their citizens.
...The state operated Medicaid before Obamacare. The state can continue to operate Medicaid after Obamacare. There were online health insurance marketplaces before Obamacare. There are several non-Obamacare insurance sales websites now that are not part of Obamacare. There can be online insurance sales without Obamacare. Obamacare did not create the ability to buy insurance online—people have been doing that for years. Obamacare did not create Medicaid. Medicaid has been available for nearly (50) years...
Of course, repealing ObamaCare would immediately shrink Kentucky Medicaid enrollment by nearly half a million, and quadruple online-insurance costs for those Kentuckians receiving subsidies...
As I have said and will continue to say: there is something wrong with anyone who publicly supports today's Republican Party without having an immediate, practical plan for utterly transforming it root-and-branch into something else.
And as I have said and will continue to say: there is something very wrong with anyone who votes for the candidates of today's Republican Party.
Over at Project Syndicate: Over at Project Syndicate:
How true is this, really? The answer appears to be: true--with perhaps a very few caveats, but important caveats:
Over at Equitable Growth: I think Paul Krugman gets one wrong--or, at least, I need more convincing before I think he gets this one right, in spite of the extraordinary empirical success of my rules (1) and (2):
...so why are companies concluding that they should return cash to stockholders rather than use it to expand their businesses? After all, we normally think of high profits as a signal: a profitable business is one people should be trying to get into. But right now we see a combination of high profits and sluggish investment. What’s going on? One possibility, I guess, is that business are holding back because Obama is looking at them funny. But more seriously, this kind of divergence — in which high profits don’t signal high returns to investment — is what you’d expect if a lot of those profits reflect monopoly power rather than returns on capital. More on this in a while. READ MOAR
...when reporters brought up the topic on June 18. Kasich suggested anyone who opposes Medicaid expansion will have to answer for their opposition when they die. Gov. Kasich said he recently told a state legislator:
I respect the fact that you believe in small government. I do too. I also happen to know that you’re a person of faith. Now, when you die and get to the, get to the, uh, to the meeting with St. Peter, he’s probably not gonna ask you much about what you did about keeping government small, but he’s going to ask you what you did for the poor. Better have a good answer....
This: "Note to Self: CBO and Part D"
OK, self-of-six-months-ago, what about the Congressional Budget Office and Medicare Part D do you want me to note?
Over at Equitable Growth: Jonathan Chait has an interesting piece on the thought on healthcare policy of the likely future senator from Iowa, Joni Ernst:
...have failed. And yet conservative opposition... has not diminished. If you want to know why this is, listen to... Joni Ernst....
We’re looking at Obamacare right now. Once we start with those benefits in January, how are we going to get people off of those? READ MOAR
I was talking to my neighbor across the street yesterday. He said:
I'm 74. I have to get my knees rebuilt now. I have to get my knees rebuilt before I can't do it anymore. I heard it on the radio. There's going to be no more medical procedures for you after 75. It's because of ObamaCare. It was designed by the mayor of Chicago, Rahm Emmanuel. And he says--he put it into the bill--that nobody should get any medical care after they are 75.
Ya think maybe Rahm Emmanuel's brother Zeke Emmanuel's musing in public right now that he doesn't want any treatment after he is 75 because he doesn't want people in the future to remember him as anything less than sharp as a tack might not have been the smartest thing for him to do if he wants to increase the American public's understanding of our health-care dilemmas?
Q: How much of regional variation in real health-care (Medicare) costs is due to the fact that some regions have sicker populations than others?
A1 (micro): If we examine how much sicker people in different regions are, and multiply the difference in average sickness by how much extra treatment sicker people get on average, we get an incremental regional R2 ~ 0.1: an extra 10%-points of the regional real cost variation can be accounted for because some regions are sicker than others.
A2 (macro): If we just regress regional real costs on some plausible indicator of regional average sickness, we get an incremental regional R2 ~ 0.5: an extra 50%-points of the regional real cost variation can be accounted for because some regions are sicker than others. READ MOAR
The extremely thoughtful Adrianna Macintyre looks down the Mississippi:
Adrianna Macintyre: GAO slams HHS over Arkansas’s Medicaid expansion budget: "On Monday, the Government Accountability Office issued a report...
...taking HHS to task for failing to assure budget neutrality in Arkansas’s Medicaid expansion, which uses Medicaid dollars to fund enrollment in private plans through the state exchange. Excerpted....
HHS did not ensure budget neutrality. Specifically, HHS approved a spending limit for the demonstration that was based, in part, on hypothetical costs—significantly higher payment amounts the state assumed it would have to make to providers if it expanded coverage under the traditional Medicaid program—without requesting any data to support the state’s assumptions.... The 3-year, nearly $4.0 billion spending limit that HHS approved for the state’s demonstration was approximately $778 million more than what the spending limit would have been if it was based on the state’s actual payment rates for services provided to adult beneficiaries under the traditional Medicaid program.
Outsourced to Richard Mayhew:
Richard Mayhew: Shame would be a good thing Public shame would be a wonderful thing...
for our political and policy processes. Abbe Gluck at Politico notes another hole and potential legally sanctionable set of statements from the Halbig team:
It is no secret that the people bringing the challenge to the Obamacare subsidies in the Halbig and King cases—challenges now seeking review from both the full D.C. federal appellate bench and the U.S. Supreme Court after federal appellate courts in Virginia and D.C. came out in opposite ways last month—are some of the same people who brought the 2012 constitutional challenge to the Affordable Care Act before the high court (the same counsel, and one of the same plaintiffs). What’s less known, however, is that in the 2012 constitutional case, these same challengers filed briefs describing Obamacare to the court in precisely the way they now say the statute cannot possibly be read. Namely, they assumed that the subsidies were available on the federal exchanges and went so far as to argue that the entire statute could not function as written without the subsidies…. From their reply brief…
Ian Millhiser: Gov. Bobby Jindal’s Bizarre Scheme To Stop His Own Education Plan By Suing The Obama Administration: "Louisiana Gov. Bobby Jindal (R) actively pushed for [the CommonCore] 2012 law...
...Recently, however, Jindal decided that he actually opposes Common Core, although he’s not been successful in convincing White, the state education board or the state legislature to join him in opposition. So Jindal... is suing the Obama Administration in federal court. If you are confused, you should be. Louisiana’s decision to embrace Common Core standards was... made by Louisiana state officials and Louisiana state lawmakers. One of them was Bobby Jindal....
The Obama Administration... administer[s]... programs... which offer money to states... [in the] Common Core.... The crux of Jindal’s lawsuit, however, is that the grant programs... violate the Constitution and federal law because they force Louisiana to enter into an entirely voluntary program that it did, in fact, enter into voluntarily.... This claim... is false...
OK. It's time to try to pull everything together on the Red States, the Republican Party, ObamaCare, "repeal and replace", and starting at the top of the evil tree and hitting every branch all the way down...
Let's start with a catch from Austin Frakt last January:
Austin Frakt: These two tweets tell you all you need to know about the politics of health reform: January 29, 2014 at 12:30 pm: Two of Avik Roy’s tweets yesterday...
...pertaining to the recently released Senate GOP health reform plan (the Patient CARE Act [of Burr (R-NC) Coburn (R-OK), and Hatch [R-UT) and discussion thereof, are very revealing.
@matthewherper: @Avik it still seems to me that this is going to hit a lot of voters harder. Even if it makes economic sense.
@Avik: .@matthewherper By repealing and replacing Ocare, the plan is more disruptive than it needs to be. But repeal needed for Right viability.
And, of course, it had no right-wing viability at all even so.
$423 billion over the next decade if the red states continue to reject Medicaid expansion. This won't be enough of a cash shortfall to send the red states into a near-permanent recession or stagnation--it's only 0.5% or so of gross economic product over the next decade. But it will hurt, and hurt a lot: the right multiplier to apply here is the Moretti long-run geographic multiplier of 6, which means that economic activity in red states in a decade will be 3% less and in blue states 1.5% more than in the baseline.
Richard Mayhew: Rejecting free money is expensive: "Forbes Magazine is using little words to explain to its readers...
...that hospitals in states that are rejecting Medicaid Expansion are hurting:
Over at Equitable Growth: I used to think (and say) that there was one clear place where low hanging fruit in healthcare cost control could be obtained: we had tried Medicare Advantage--putting Medicare patients into HMOs--and it turned out that they cost the federal government more money when we did that, and the patients were less satisfied and did worse. Medicare HMOs thus looked like a bad bet for the health care system of the future, and one that we should not make. READ MOAR
And after a long drought Richard Mayhew of Balloon Juice comes through with a high-quality DeLong Smackdown! Yay!!
Richard Mayhew: Brad Delong Smackdown Watch "Brad Delong has an impressive set of thoughts...
...on PPACA implementation and a path of the future. I think he is getting one thing significantly wrong.... Recently, I wrote about AIDS medications and Gresham’s law applying to health insurance. I think this is the first salvo of the “brainpower health insurance companies devoted to gaming the system” as it is the most obvious target to create policies that are amazingly ugly to people with chronic, expensive conditions. One of the major challenges for Obamacare is transitioning the health insurance industry from being extremely competent at finding ways to not covering sick people towards finding ways to keep people from getting too sick. The biggest stick in this transition is the massive sea change in underwriting from exclusionary, statistical and experience underwriting to an inclusionary community rating system of underwriting. This change, as we have discussed ad nauseum, allows all people, including those with expensive pre-exisiitng conditions to get insurance. It is why the Exchange risk pools are sicker, on average, than the risk pools of the pre-Exchange underwritten individual insurance markets as those markets kept the sick people who could actually need services out of the market.
Over at Equitable Growth: Coffee yesterday with Peter Gosselin. Back in the day, when he worked for the Los Angeles Times he was one of the very very very best reporters covering American healthcare and related subjects. Then he was Tim Geithner's speechwriter. Now he is doing something at
And at coffee he put me on the spot. He asked me what big thoughts I had about the implementation of the Affordable Care Act.
So I stammered something relatively incoherent...
Now, however, I have had a chance to regroup. I have had an opportunity to bring some things that were barely or unconscious into the full light of reason. So I would like to try to do a better job...
Ten points: READ MOAR
Sarah Kliff: Separate circuit court rules in favor of Obamacare subsidies: "The Fourth Circuit Court of Appeals...
ruled Tuesday afternoon that Obamacare subsidies could be offered through federally-run insurance marketplaces.
It is... clear that widely available tax credits are essential to fulfilling the Act’s primary goals and that Congress was aware of their importance when drafting the bill," the Fourth Circuit Court ruled.
We'll have more coverage soon...."
Over at Equitable Growth: Nicholas Bagley: ObamaCare and Halbig: What Does This Morning's Decision Mean?: "In a major setback for the Affordable Care Act...
...the D.C. Circuit just released a fractured opinion invalidating the IRS’s rule extending tax credits to federally facilitated exchanges.... About two-thirds of the states... declined to establish exchanges. In those states, the federal government stepped in and established the exchanges on the states’ behalf. In today’s opinion, the D.C. Circuit held that a federally facilitated exchange isn’t “established by the State under 1311.” As a result, the IRS can’t offer tax credits to those who purchase plans on such exchanges... the average estimated tax credit in 2014 is $4,700.... READ MOAR
The percentage of uninsured Californians has been cut in half since the federal health law began expanding coverage nine months ago, according to a new national survey. In September of 2013, 22 percent of California adults were uninsured. By last month, that number had fallen to just 11 percent, the biggest drop among the nation’s six largest states. The survey of more than 4,400 people by the Commonwealth Fund, a national healthcare foundation, also found that nationwide, the uninsured rate fell from 20 percent to 15 percent during the same period.... The Commonwealth Fund survey found that 61 percent of those who were newly insured said they felt better off thanks to their new coverage. And nearly four out of five said they were somewhat or very satisfied with their new coverage.
The survey also found that since last year, awareness of the Affordable Care Act has increased significantly, although that awareness still lags among poorer Americans. For example, more than half of the poorest people surveyed still did not know that the federal health law makes subsidies available to help pay for health insurance.
I must say that where the rubber meets the road this thing is doing somewhat better than I expected back at the end of 2009. But the big question will be: what will be the deltas for health and economic security?
￼￼“It is up to us to make the right choice - the human choice - and live in a place where working Missourians get a fair shake. A place where someone who works two jobs can afford to see a doctor when they are sick. A place where everyone lives longer, healthier, fuller lives...” – Governor Jay Nixon
What is Medicaid?
Medicaid provides health care services to low-income Missourians, their children and people with disabilities. About 829,000 Missourians receive Medicaid services, including 503,000 children; 158,000 people with disabilities; 75,000 seniors; 72,000 low income adults; and 21,000 pregnant women. Currently, Medicaid is funded through a combination of 63% federal funds and 37% state funds.
Jonathan Chait vs. Peter Suderman on ObamaCare:
Jonathan Chait: Libertarian Accidentally Shows Obamacare Success: "The Commonwealth Fund has a new survey...
...showing that the proportion of adults lacking health insurance has fallen by a quarter, from 20 percent of the population to 15 percent. (Most respondents, including 74 percent of newly insured Republicans, report liking their plan.) Also, this week, the Congressional Budget Office again revised down its cost estimates for Medicare, which now spends $50 billion a year less than it was projected to before Obamacare passed. Also, the New England Journal of Medicine recently estimated that 20 million Americans gained insurance under the new law.
The latter study comes in for criticism by Peter Suderman, Reason’s indefatigable health-care analyst.
Over at Equitable Growth: Let us focus on the macroeconomic costs of not expanding Medicaid. That is, let us leave to one side the question of exactly how much good getting people on Medicaid does for them. We know that it makes safety-net hospitals Financial stress level lower--there is less uncompensated care, and that flows through to corners that do not need to be cut. We know that it increases incomes of nurses and doctors somewhat. We know that patients on Medicaid go to the doctor more than the uninsured, and that by American standards at least the uninsured do not go to the doctor enough and do not take enough medicine. We know that the ex-uninsured are much happier, less stressed, and non-bankrupt. READ MOAR
Over at Equitable Growth: Back in the 1920s the Progressive-Republican founder of The 20th Century Fund--now The Century Foundation—-Edward Filene argued that America did not need any flavor of "socialism". What it needed instead, he argued, was "welfare capitalism".
Socialism imposed heavy taxes and used the resulting revenue to provide for social welfare. In so doing it incurred all the efficiency losses of bureaucracy. It added to those the losses from coalition-building political logrolling. It added on to those the efficiency losses that ensued from decisions made by politicians responsible to voters who were by and large not the entrepreneurial job creators. More important, in his view, the redistributive part of the social insurance state was simply not necessary. The efficiencies of scale of modern mass production would guarantee that even an unequal society would be a society of general abundance and prosperity. READ MOAR
"I now know it is a rising, not a setting, sun" --Benjamin Franklin, 1787