Must-Read: CBO: American Health Care Act: "CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law...
Should-Read: Two possibilities:
Paul Ryan and company are simply not competent--somebody put a real, highly punitive continuous coverage requirement into the ObamaCare Repeal bill; somebody else said "that's too punitive" and changed it; and nobody did the addition.
Paul Ryan and company want this bill--if passed--to lead to an adverse selection meltdown of their (or, rather, Trump's) health care exchanges.
Is there a third alternative?
Aaron Carroll: The AHCA Doesn’t Make Sense: "I’m having a really hard time with this...
Should-Read: Sarah Kliff: Tom Price is lying about the GOP health plan: "Health and Human Services Secretary Tom Price made a bold promise during a Sunday morning interview with Meet the Press...
Live from the Republicans' Self-Made Gehenna: It would be interesting to hear what the real Republican health care experts say about the plan to repeal ObamaCare, if any of them dare say much of anything:
Kevin Drum: Emperor's Clothes Blogging: "I've been trying to figure out how to respond to the Republican health care plan...
Notes for forthcoming Econ 210b discussion: Tuesday March 7, 2017; Evans 65: 10 am: Robert Allen (2009): The British Industrial Revolution in Global Perspective | <http://amzn.to/2mR3bKX>
Start with the mysterious "Pseudoerasmus": Random thoughts on critiques of Allen’s theory of the Industrial Revolution:
I love the work of Robert Allen... steel... the Soviet Union... English agriculture. And his little book on global economic history—is there a greater marvel of illuminating concision than that?... His point of departure is always the very concrete reasons that a firm or an industry or a country is more productive than another. I’m not rubbishing institutions or culture as explanations—I’m just saying, Allen’s virtue is to start with problems of production first. Yet I always find myself in the peculiar position of loving his work like a fan-girl and disagreeing with so much of it. In particular, I’m sceptical of his theory of the Industrial Revolution.
Should-Read: Jonathan Chait: Trump’s Health-Care Nightmare Is Only Just Beginning: "Republican members of Congress do not agree with each other on the parameters of a replacement...
Should-Read: James Kwak: Health Care and John D. Rockefeller’s Dog: "Few people actually want to live in a world where health care is distributed by a free market...
Must-Read: The right moment for Republicans interested in health policy to intervene in the politics was back in 2010, when the "repeal and replace" meme was first decided on. They should have said: "Hell, no!--You really do not want to say that."
My suspicion is that they thought the battle was not worth fighting because the dog would never catch the car. The least they could do is apologize to the rest of us now...
David Anderson: Governing Is Hard: "The Republican Party has an ACA problem. The ACA is deficit reducing...
Should-Read: Alan Smith and Federica Cocco: The huge disparities in US life expectancy in five charts: "Inequality means that individuals in the US have very different experiences...
Live from the Orange-Haired Baboon Cage: The orange-haired baboon is far from being the only baboon in the cage:
Scott Lemieux: Just How Monstrous is the Contemporary GOP?: "Matt Lewis discovers that why Republicans never have an alternative health care plan. Perhaps the most instructive part of the piece is this bit of throat-clearing:
Conservative philosophy—from Burke to Hayek—suggests that comprehensive plans are a fatal conceit; the world is too complex to plan. The notion that Republicans could magically “fix” the largest sector of the world’s largest economy is dubious, at best.
Sure, every other liberal democracy in the world uses more government intervention to deliver health care to everyone for considerably less money. But “philosophy” tells us that this is unpossible! Cf. Edumund Burke on the French Revolution.
Will competition in health insurance survive?
The answer now is “perhaps”.
The federal courts, at their lowest district court level, have just weighed in on the side of more competition and fewer behemoth health insurance companies; on the side of more competition and fewer monopolies and near monopolies. This matters for consumers: monopolies are bad news, and monopolies where what is being sold is a very expensive necessity—which health insurance coverage is—very bad news for consumers, and so for societal well-being. If we are to retain a market-based health insurance system, people need effective options. A market in which there is only one insurance company, or two companies that collude to match each other’s prices, has all the bureaucratic drawbacks of a single-payer system plus all the drawbacks of a monopoly.
The coming of agriculture would seem to have only pluses:
What's the downside? Jared Diamond says that there are very powerful downsides to the invention of agriculture and the adoption of an agricultural lifestyle? What are they? Is he right?
Must-Read: Looking forward at the Trump administration, it now seems very clear that under the Trump administration policy will be:
Therefore, it seems important that as much as possible should be done to encourage:
Nicholas Bagley has the ObamaCare front on this:
Nicholas Bagley: Patching Obamacare at the State Level: "If Congress zeroes out the individual mandate—and my hunch is that it will—it’s game over for the exchanges...
Duncan Black: Eschaton: America's Worst Humans: "Chris Cillizza. I'm sure Cillizza got his career opportunities through nothing other than the pure meritocracy...
...that exists in our free market Nirvana. Certainly he got none of the breaks that blah people do. Still if he wasn't doing this, I don't see how he wouldn't be under a bridge somewhere.
Scott Lemieux: Love Is Always Scarpering, Or Cowering, Or Fawning: "This month’s Cillizza Award for Outstanding Achievement in the Field Of Hackdom goes to… Chris Cillizza:
@TheFix: You should watch this Paul Ryan town hall on CNN. The guy is extremely impressive.
@OnceUponA: It is very difficult to have a working understanding of health policy and simultaneously be impressed by his answers on ACA. https://t.co/NTdpL9gTIw
Ah. Memories of 1981...
Back in 1981 the Reagan administration promised big tax cuts for the rich; higher defense spending; no spending cuts in programs that were really useful but only in rent-seeking waste, fraud, and abuse; and a balanced budget. They didn't add up. They went forward anyway.
The consequence was the huge full-employment Reagan budget deficit, and gave America a Hobson's choice between:
Mitt Romney (2012): Secret 47% Video:
Romney: ...And I guess everybody here is a dignitary, and I appreciate your help. And by the way, I am serious about the food. Bring that... clear the place, but Hilary has to eat her beets... [Audience laughs.]
October 22, 2016 at 12:16 PM in Economics: Health, Economics: Inequality, Moral Responsibility, Obama Administration, Philosophy: Moral, Political Economy, Politics, Streams: (Weekend) Reading, Streams: Across the Wide Missouri, Streams: Cycle, Streams: Economics, Streams: Equitable Growth | Permalink | Comments (1)
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J. Bradford DeLong and Michael M. DeLong: Beating America’s Health-Care Monopolists: BERKELEY – The United States’ Affordable Care Act (ACA), President Barack Obama’s signature 2010 health-care reform, has significantly increased the need for effective antitrust enforcement in health-insurance markets. Despite recent good news on this front, the odds remain stacked against consumers.
As Berkeley economics professor Aaron Edlin has pointed out, consumer abstention is the ultimate competitor. Companies cannot purchase or contrive a solution to consumers who say, “I’m just not going to buy this.” But the ACA requires individuals to purchase health insurance, thus creating a vertical demand curve for potential monopolists. Under these conditions, profits – and consumer abuse – can be maximized through collusion. Read MOAR at Project Syndicate
Must-Read: Richard Mayhew: A Thousand and One Posts:
Wow, that last post was my 1,000th post here at Balloon Juice. I was not expecting that when I first got started here...
Live from Trumpland: Who is attracted to voting for Trump? And why am I not--even as more than half of my income class is going to pull the lever for Trump this fall? Is it my urbanity? My education level? My unwillingness to fall for one of the most obvious grifts on the planet? The fact that I took too many American Studies courses as a child and so identify not as "white" but as "Yankee"--a descendant predominantly of East Anglian and Severn Valley Puritans, the position of whose culture and values in America today is not a result of relative numbers?
Josh Marshall wrestles with this hard problem, and comes up with a Polanyiesque interpretation: the disappointment by the market economic system of what had been thought as reasonable expectations leads to a politics of revenge--but not just of revenge against the Masters of the Universe, revenge against those who are somehow getting above themselves and getting free stuff:
Josh Marshall: Trumpism is a Politics of Loss and Revenge:
Trump support is highly correlated with areas experiencing rising mortality rates for whites--a massively important societal development, in addition to a tragedy....
Must-Read: Aaron Carroll: Helpless to Prevent Cancer? Actually, Quite a Bit Is in Your Control:
Of the nearly 90,000 women and more than 46,000 men, 16,531 women and 11,731 men fell into the low-risk group....
Must-Read: The extremely sharp Jonathan Chait sends me to one of today's must-reads...
Back when John Roberts as Chief Justice of the Supreme Court did not nullify RomneyCare--excuse me, ObamaCare--from the bench but did lawlessly and without precedent give states the option to nullify the Medicaid expansion part of ObamaCare, I thought that this was a meaningless sop thrown to the right.
My smarter wife Ann Marie Marciarille disagreed. I thought that every governor and state legislator who could add would do the math and note the expanding Medicaid would allow them to do lots of things at the state level--open hospitals and clinics, engage in initiatives, take money that would otherwise have been used to provide uncompensated care and use it for other programs and to fund tax cuts. It was certainly true that I could not find a Republican governor or state legislature who would, in private, say that they welcomed Roberts's nullification-option decision: they all would rather have been forced to expand Medicaid so that they could have spent the money and inveighed against unconstitutional big government tyranny. And so I expected that they would find some way to get it done: find some way to minimize the ideological hit and still get Medicaid expanded so that they could spend the money to expand programs to make their citizens healthier and lower taxes.
I was wrong.
Rather than being a symbolic victory for the right but a substantive nothingburger, John Roberts's lawless creation of the Medicaid expansion-nullification option, when interacted with the poisonous identity politics of Republicans, looks from any kind of technocratic policy perspective that values lower mortality and morbidity like a truly damnable deed--as we see now, as the icejam of cruel policy begins to break:
Patients burst into tears at this city’s glistening new charity hospital when they learned they could get Medicaid health insurance...
Over at Equitable Growth: James Kwak has, I think, an attack of pessimism of the will--declares that our current dysfunctional economic institutions and policies benefit the "financial institutions, financial professionals, corporate executives, and rich people" who "basically control the American political system", and so "things are unlikely to change anytime soon".
And the uninsured rate is likely to dip below 8% when the remaining nullification states finally expand their Medicaid programs.
Read MOAR Over at Equitable Growth
Can This Capitalism Be Saved?
Here is piece of mine left on the cutting room floor elsewhere. So I might as well throw it up here.
Reviewing: Robert Reich: Saving Capitalism: For the Many, Not the Few http://amzn.to/29Viz6w
Robert Reich’s Saving Capitalism: For the Many, Not the Few http://amzn.to/29Viz6w is an excellent book. It powerfully argues that America needs once again—as it truthfully reminds us that we did four times in the past—restructure its institutions to build both private and public countervailing power against the monopolists and their political servants in order to right the distribution of income and boost the pace of economic growth.
Live from the Republicans' Self-Made Gehenna: Zack Beauchamp finds a Republican validator--one of those who has spent most of the past decade stridently arguing that ObamaCare will make America a worse place and needs to be repealed-and-replaced--in the midst of what appears to be a nervous breakdown:
I don’t think the Republican Party and the conservative movement are capable of reforming themselves in an incremental and gradual way.... The conservative movement is fundamentally broken. Trump is not a random act.... Goldwater... a historical disaster....
Hoisted from Four Years Ago: What passes for Republican think-tannery these days. Judge Paul Friedman's smackdown should have ended this then--rather than later, at the Supreme Court, 6-3, with John Roberts writing:
Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible we must interpret the Act in a way that is consistent with the former, and avoids the latter...
The idiocy, from Michael Cannon and Jonathan Adler:
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 (7)
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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
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!
The purpose of this weblog is to be the best possible portal into what I am thinking, what I am reading, what I think about what I am reading, and what other smart people think about what I am reading...
"Bring expertise, bring a willingness to learn, bring good humor, bring a desire to improve the world—and also bring a low tolerance for lies and bullshit..." — Brad DeLong
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