Grasping Reality on TypePad, by Brad DeLong

Paul Krugman: How Democrats Can Deliver on Health Care: "What did the campaigns that led to a blue wave talk about? Above all, health care, which featured in more than half of Democrats’ ads. Which raises the question: Now that Democrats have had their big House victory and a lot of success in state-level races, can they do anything to deliver on their key campaign issue?Yes, they can...

Of historical interest only: Hoisted from the Archives: An Unrealistic, Impractical, Utopian Plan for Dealing with the Health Care Opportunity: First, it's definitely not a plan, and it's certainly not a proposal for the current or any forseeable future policy and political environment. Think of it as a utopia—and think of it as a utopia coming from a guy who is not a real health economist but has an undeserved reputation because he was good at translating the economese spoken by real health economists like David Cutler, Sherry Glied, Ken Thorpe, Len Nichols, et cetera in a way that made it intelligible to senior Bentsen aides like Marina Weiss and Michael Levy.

So here it is:

Today: The dirty little secret is that serious legal arguments are those that lawyers pretend to take seriously. If enough Republican hacks decide to pretend that Judge Reed O'Connor is serious, he becomes serious. My forecast? The Fifth Circuit narrowly upholds O'Connor, and then it goes down 8-1 in the Supreme Court—unless one of the Democratic justices dies or retires before the decision is announced, it which case O'Connor is upheld 5-3.

Jack Balkin wants to maintain two positions at once:

1. "The lesson of Sebelius is that if you give enough very smart lawyers enough time to work on a legal problem, they can come up with creditable arguments for many (but not all) legal positions, even if, when the task started, the position seemed hopeless..."

2. "I am most certainly not saying that legal argument and legal craft are mere disguises for political ideology or that they have no independent significance. I have been trained as a lawyer and I express opinions about the quality of legal arguments all the time. It is my job to do so. Thus, whether lawyers are willing to support a given claim depends on their perception of the quality of the legal reasoning and the quality of the legal arguments that can be advanced for it..."

But the second means almost nothing if "creditable" arguments can be constructed for nearly everything, and the task of law professors is then to retrospectively justify whatever the judges pick. The first means little if the legal community does have strong standards for what is a strong argument. How to resolve this? By noting that whatever gets five votes on the Supreme Court is retrospectively turned into the strongest arguments. And Supreme Court justices are very good at convincing themselves that what upholds their ideology and partisan position is in fact the best-argued and best-crafted.

Jack Balkin: Texas v. U.S: Off the Wall and On the Wall in the Age of Trump: "The judge's arguments are not even close to being persuasive given existing legal precedents. Does that mean that the position is 'off-the-wall'?... Asking whether a legal claim is 'off-the-wall' is a question of whether it is a reasonable claim, or at least one on which reasonable minds can differ.... But the perceived quality of legal reasoning and legal arguments are not exogenous from social influence...

No surprise: throwing people off Medicaid has substantial costs and no benefits at all: Thomas DeLeire: The Effect of Disenrollment from Medicaid on Employment, Insurance Coverage, Health and Health Care Utilization: "From July through September 2005, TennCare, the Tennessee Medicaid program, disenrolled approximately 170,000 adults following a change in eligibility rules...

Nancy L. Yu, Preston Atteberry, Peter B. Bach: Spending On Prescription Drugs In The US: Where Does All The Money Go?: "The US pharmaceutical industry is characterized by a complex and often opaque system of distribution and reimbursement...

https://www.icloud.com/keynote/0GHqV3TinhaI6-9xChQ1a0R5Q#DevEng_215_Slides

Berkeley Economics Departmental Seminar: Sociological distance, present and the legacy of past discrimination, and preventive treatment in Oakland, CA: perhaps 20% of the black-white cardiovascular health gap due to the fact that Black patients are seen by sociologically-distant white doctors: Marcy Alsan et al.: Does Diversity Matter for Health? Experimental Evidence from Oakland: "We study the effect of diversity in the physician workforce on the demand for preventive care among African-American men...

Ann Marie Marciarille: Implementation Considerations for Universal Coverage: ERISA: "What About State Specific Health Care Reform?...

People are not effective price-sensitive consumers for health insurance. We can argue why they are not. But first we need to admit that we are not: Zarek C. Brot-Goldberg, Amitabh Chandra, Benjamin R. Handel, and Jonathan T. Kolstad: What does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics: "We leverage a natural experiment at a large self-insured firm that required all of its employees to switch... to a nonlinear, high-deductible plan...

We really do not know what effect a trade war would have on the global economy. All of our baselines are based off of what has happened in the past, long before the age of highly integrated global value chains. It could be small. It could be big. The real forecast is: we just do not yet know: Dan McCrum: Trade tension and China : "The war on trade started by the Trump administration is percolating through the world's analytical apparatus.... Tariffs could be bad for the global pace of economic activity, but only if the economic warfare escalates...

• Ann Marie Marciarille: David Slusky on The Impact of the Flint Water Crisis on Fertility: "K.U.'s David Slusky gave an interesting talk on "The Impact of the Flint Water Crisis on Fertility".  A 4.9% decrease in birth weight is hard to ignore...

• Austin Frakt: Reagan, Deregulation and America's Exceptional Rise in Health Care Costs: "Why did American health care costs start skyrocketing compared with those of other advanced nations starting in the early 1980s?...

Comment of teh Day: Erik Lund: : "In the last post on this theme, Japan's early success in replicating Armstrong-pattern guns in domestic arsenals was mentioned...

The eight 24-hour red-curb emergency special permit we-will-tow parking spots just outside UCSF Medical's Betty Irene Moore Women's Hospital are reserved...

...three for health care administration, two for capital programs, one for campus planning, one for budget, and one for the obstetrician on call...

Jo Mannies: On Twitter: "At Truman Dinner, @clairecmc asks everyone to stand up who has a preexisting condition. Notes GOP wants to eliminate insurance coverage for them. Most of ballroom stands up:..."

Ann Marie Marciarille: Minutes Matter, Don't Wait!: "Or so my local 'Emergency Room of Brookside' bleats from its website  but, even more oddly, from the pop up advertising that is dogging my web browsing these days...

This is what I want when I call for a better class of DeLong Smackdowns! How do we think this looks not just nine years after my optimism in 2009 back at the end of the American century but five years after Matt wrote?:

Hoisted from the Archives: Matthew Yglesias (2013): May Day Marxism: Capitalism is looking pretty shabby: "DeLong reposted a very interesting 2009 talk... "Understanding Karl Marx"... that I would have enthusiastically endorsed in 2009 but which look weaker four years later...

Noah Smith: Noahpinion: Handwaving on health care: "There's a particular style of argument that some conservative economists use to dismiss calls for government intervention in markets:

• Step 1: Either assert or assume that free markets work best in general.
• Step 2: List the reasons why this particular market might be unusual.
• Step 3: Dismiss each reason with a combination of skeptical harumphing, handwaving, anecdotes, and/or informal evidence.
• Step 4: Conclude that this market should be free from government intervention.

In a recent rebuttal to a Greg Mankiw column on health care policy, John Cochrane displays this argumentation style in near-perfect form.

Should-Read: Michael Geruso and Timothy Layton: Selection in Health Insurance Markets and Its Policy Remedies: "We begin by outlining some important but often misunderstood differences between two types of conceptual frameworks... http://www.nber.org/papers/w23876

Must-Read: Stuart Butler is the person who knows something about health care who should, given his values and his analytical judgments, be most favorably inclined toward Graham-Cassidy. He is strongly opposed: "[a] high probability of really bad outcomes..." is his bottom line.

And nobody else of any reputation or note has even as favorable a judgment...

Ezra Klein: Graham-Cassidy could’ve been the GOP’s best Obamacare replacement: "Instead, Lindsey Graham and Bill Cassidy wrote the worst plan yet... https://www.vox.com/policy-and-politics/2017/9/20/16333384/graham-cassidy-obamacare-health-care

Sigh: See what I meant http://www.bradford-delong.com/2017/09/monday-smackdown-smackdown.html about Monday Smackdowns? Such a target-rich environment...

Must-Read: There are, as is always the case these days, a lot of lies in Avik Roy's latest on health care "reform".

But there is one nugget of important truth. Here it is:

Avik Roy: Take Two: Inside Bill Cassidy's Plan To Replace Obamacare: "Because Graham-Cassidy repeals Obamacare’s individual mandate, and the Congressional Budget Office views the individual mandate as driving the majority of Obamacare’s coverage expansion, the CBO is likely to view Graham-Cassidy the same way it has viewed other GOP bills..." https://www.forbes.com/sites/theapothecary/2017/09/17/take-two-inside-bill-cassidys-plan-to-replace-obamacare/#5703ca351181

About a month and a half ago I decided that there was really no place in any of my classes for my "what you really ought to know about doing economics" lecture http://www.bradford-delong.com/2017/07/how-to-think-like-an-economist-if-that-is-you-wish-to.html: it would be either incomprehensible (because students would not understand it) or unnecessary (because students would already know it).

Should-Read: "Unconstitutional but need to be made in a legal way..." is a very interesting category of congressional action.

Let us be very clear: the exchanges in blue states are in much better shape, and state governments can do a lot to shore them up and are willing to step in if the federal government drops the ball. It's red states where the insurance exchanges are in trouble and where state governments lack the technocratic knowledge and the free cash flow needed:

Cameron Joseph and Tierney Sneed: After Obamacare Repeal Collapse, GOP Weighs Whether To Help State Markets: "Most Republicans have been happy to watch some state-level individual health insurance exchanges sputter... http://talkingpointsmemo.com/dc/after-obamacare-repeal-collapse-gop-weighs-whether-to-help-state-health-exchange-markets

Should-Read: Ian Millhiser: What it’s like to watch the Senate debate whether your life is as valuable as a tax cut for Trump: "Every other Saturday morning, I inject $2,269.61 worth of pharmaceuticals into my leg... https://thinkprogress.org/chronic-condition-trumpcare-scares-me-b2192446ea64

Comment of the Day: Sanjait: Avik Roy told a lot of lies in his vain attempt to get BCRA passed...: "Sure, because removing hundreds of billions from insurance programs and subsidies... http://www.bradford-delong.com/2017/07/should-read-avik-roy-told-a-lot-of-lies-in-his-vain-attempt-to-get-bcra-passed-now-here-he-is-calling-for-the-corrupt.html?cid=6a00e551f08003883401bb09b3c897970d#comment-6a00e551f08003883401bb09b3c897970d

Live from the Orange-Haired Baboon Cage: Josh Marshall asks for theories of Hero McCain. I have three:

1. After 10 years of being a largely-destructive Republican—most notably in his injection of Sarah Palin into our public sphere—he simply decided: f--- it, it's time to be an American and a senator again.

2. Roid rage: steroid doses to reduce brain swelling after surgery put him in a temper.

3. There are fourteen Republican senators—Susan Collins, R-ME, Lisa Murkowski, R-AK, John McCain, R-A, Dean Heller R-NV, Lamar Alexander R-TN, Shelley Moore Capito R-WV, Rob Portman R-OH, Bob Corker R-TN, Tom Cotton R-AK, Lindsey Graham R-SC, Mike Lee R-UT, Jeff Flake R-AZ, Ben Sasse R-NB, Jerry Moran R-KS—plus 50 Republican representatives who would rather that this ObamaCare repeal thing crash. Murkowski and Collins could oppose repeal and strengthen their local political standing. The question was who else would join them—and would it be better to oppose it in a group or to simply put up one of their number so that McConnell could say "I really tried hard", and they decided that it was better for it to barely fail, and then McCain wanted the Mr. Smith role.

Opinions?

Josh Marshall: Taking Stock Of Trumpcare’s Epic Collapse – Talking Points Memo: "I had a very hard time believing the result would be what it turned out to be... http://talkingpointsmemo.com/edblog/taking-stock-of-trumpcares-epic-collapse

Should-Read: Antonio Fatas seems annoyed with Greg Mankiw. I think I understand where Antonio is coming from: one has a moral obligation, I think, not just to say "health care is a complicated issue", but to go on and say what kinds of "regulatory relief" and what kind of "expanded government role" you believe would do more good than harm—and also (we are still looking at you, Marty) not to misreport and misconstrue the solid empirical literature, and also (here we are looking at you, Greg) to say more than that the issues are "hotly debated":

Antonio Fatas: On Twitter: "Healthcare is complicated but Greg Mankiw should criticize policy proposals that are incoherent or just lie about their benefits..." https://twitter.com/AntonioFatas/status/890979381719511044

Live from the Orange-Haired Baboon Cage: The twelve not completely crazy Republican senators who might be open to some form of not-insane health care legislation over the next fifteen months:

• Susan Collins R-ME
• Lisa Murkowski R-AK
• John McCain R-AZ
• Dean Heller R-NV
• Lamar Alexander R-TN
• Shelley Moore Capito R-WV
• Rob Portman R-OH
• Bob Corker R-TN
• Tom Cotton R-AK
• Lindsey Graham R-SC
• Mike Lee R-UT
• Jerry Moran R-KS

Comment of the Day: JEC: HOW WOULD HEALTH-CARE REFORM AFFECT PATIENT HEALTH?: "I'd also point out that Marty is performing the 'null hypothesis bait-and-switch', which relies on nobody noticing that you've swapped the maintained and null hypotheses... http://www.bradford-delong.com/2017/07/must-read-naughty-naughty-marty-you-know-better-you-say-patients-in-the-oregon-medicaid-study-show-no-signif.html?cid=6a00e551f08003883401b8d299d84a970c#comment-6a00e551f08003883401b8d299d84a970c

Must-Read: Naughty, naughty, Marty...

You know better.

You say: "Patients in the Oregon Medicaid study show no significant improvement in clinical physical health outcomes". You know as well as I do that you should say: "Patients in the Oregon Medicaid study showed the expected and clinically significant improvement in physical health outcomes, but the study had low statistical power, and so the researchers could not dismiss, at conventional levels of statistical significance, the possibility that the improvement was due to chance."

Back in the early 1980s you used to try very hard to teach your students not to confuse statistical significance with economic significance.

What has happened?

Martin Feldstein: How Would Health-Care Reform Affect Patient Health?: "People who qualify for Medicaid do receive substantially more care than those without formal insurance... https://www.project-syndicate.org/commentary/us-health-care-reform-medicaid-cuts-by-martin-feldstein-2017-07

Hoisted from the Archives: Yesterday I was bitching to the team at "ParsonsTKO | A Digital Transformation Agency" http://parsonstko.com/, which is in charge of thinking about the redesign of the Equitable Growth Website http://equitablegrowth.org, about not just our failure but the general failure of the internet to bring things from the stock into the flow—to have a memory. The original hope was that Google http://google.com would be that memory, but full-text combined with word-nearness search plus pagerank does not do the job. So I was arguing that Equitable Growth should hire somebody whose job—at least part of whose job—is to ask: what is the thing that Equitable Growth has ever published that is most relevant to live concerns and issues today?; and then repost and highlight that thing. Plus we need an indexing grammar, ontology, whatever, that makes the most relevant thing easy to search for and find.

But I can do this for my own website, myself—if I find time. So here we are: what the country should be doing about ObamaCare right now, hoisted from my archives from 2004:

Reading Reihan Salam's "Why I signed up for Obamacare": The Honest Broker for the Week of May 10, 2014: So this morning I am reading the highly-intelligent Reihan Salam's bill of indictment against ObamaCare... http://delong.typepad.com/delong_long_form/2014/05/reading-reihan-salams-why-i-signed-up-for-obamacare-the-honest-broker-for-the-week-of-may-10-2014.html

Should-Read: Josh Barro: GOP healthcare bill will poll badly no matter what: "Now I have to call those providers' offices and get duplicate receipts and upload them and allow seven to 10 days for processing... http://www.businessinsider.com/gop-healthcare-bill-polls-bad-changes-2017-6

David Bradley Isenberg: I Only Protested the Affordable Care Act Because the President Was Black. Please Don’t Take Away My Health Insurance: "Back in 2009, when the Patient Protection and Affordable Care Act was being debated in Congress, I was fuming with anger... https://www.mcsweeneys.net/articles/i-only-protested-the-affordable-care-act-because-the-president-was-black-please-dont-take-away-my-health-insurance>

Must-Read: I don't think any—statistically literate—conservatives believe Medicaid is worthless. Statistically illiterate ones may, and there may be many people who have taken great care to maintain their statistical illiteracy. But the truest core argument—if, as Thomas Hobbes once translated Thoukydides, "the least in speech"—is not that Medicaid is worthless, but that the lives of those who need Medicaid are worth little, and not worth spending public money on. They may say that they believe the first—that Medicaid is worthless. But that, I believe, is, for the statistically literate and for those who have worked hard to remain statistically illiterate, pretense: what they believe is that the lives of those who need Medicaid are worth little.

Ezra Klein: Conservatives believe Medicaid is worthless, so slashing it is harmless. They’re wrong: "Expanding Medicaid saves lives at a cost of $327,000 to $867,000 per life saved... https://www.vox.com/health-care/2017/6/29/15885796/medicaid-senate-gop-health-bill-benefits-bcra

Must-Read: as Eric Rauchway says, Ezra Klein is now shrill. But Ezra understates the problem. Note that there are now very, very few Republican health-care policy experts releasing their own—truly conservative—plans, or criticizing the current plan for not achieving sensible conservative goals. The radio silence from those who should be doing the heavy lifting on GOP-conservative health policy thinking is near total, and is deafening:

Ezra Klein: It turns out the liberal caricature of conservatism is correct: "It’s depressing. But it’s true: Marc Thiessen, the George W. Bush speechwriter... is aghast at the Senate GOP’s health care bill... https://www.vox.com/policy-and-politics/2017/6/29/15892504/liberal-caricature-conservatism-correct

Should-Read: Is this for real? I think Erica Grieder fails the Turing test. Guys and gals at The Week: this is no way to build the reputation as a trustworthy information intermediary you need to survive as anything other than a monstrous clickbait and eyeball-glue farm:

The "losers" from ObamaCare are "young invincibles" being charged more for their insurance because of the mandate and the cross-subsidization from young to old (and who will benefit in their turn when they get old), and people who had had cheap low-quality insurance who now have much better and somewhat more costly insurance. The second group are big winners in any sensible actuarial sense. The first group are net winners as well because they will age and they will develop "preexisting conditions".

But even if Grieder's claims about "losers" from ObamaCare weren't fatuous, to complain about ObamaCare because it "raises premiums and deductibles" for some and "left millions... uninsured" while providing enormous net benefits in terms of coverage, treatment, and health and then turn around and endorse BCRA which raises premiums and deductibles even more and leaves an extra 22 million uninsured...

These are the words of a TrumpBot. Not of a reporter:

Erica Grieder: The GOP's 'Better Care' act is better than you think: "While the Affordable Care Act has surely helped millions of Americans... http://theweek.com/articles/707712/gops-better-care-act-better-than-think

Should-Read: Scott Lemieux: No Vote on TrumpCare In June: "This really is important... http://www.lawyersgunsmoneyblog.com/2017/06/no-vote-trumpcare-june

Must-Read: http://vox.com gave eight Republican senators as much rope as they wanted...

Nobody wanted to say: "this Reconciliation Bill is imperfect, but it keeps the ball rolling, and after Trump signs it the real bipartisan bargaining will commence..."

Nobody wanted to say: "I will be primaried and may lose if I cannot say: 'We in the senate did our job and passed ObamaCare repeal and I was there pushing when it happened..."

And it appears that nobody had given any thought to how they were going to answer substance questions from reporters. Which, I suppose, tells us a lot about how often anybody other than http://vox.com tries to get senators to answer substance questions:

Tara Golshan, Dylan Scott, and Jeff Stein: We asked 8 Senate Republicans to explain what their health bill is trying to do: "Vox asked GOP senators to explain their hopes for it. Who will benefit from the legislation? What problems is this bill trying to solve?.. https://www.vox.com/policy-and-politics/2017/6/16/15810524/senate-ahca-explain-please

We have sent our letter, and Sarah Kliff is on it!

Sarah Kliff: 6 Nobel Prize–winning economists announce opposition to Senate health bill: "Forty economists, including six Nobel laureates, sent a letter Monday to Senate Majority Leader Mitch McConnell (R-KY) outlining their opposition to the Better Care Reconciliation Act, the Senate bill to repeal and replace Obamacare... https://www.vox.com/policy-and-politics/2017/6/26/15873980/economist-nobel-prize-oppose-senate-repeal

...“At a time when economic change is making life more difficult for all but the relatively well-to-do, denying people to access health insurance is a giant step in the wrong direction,” the letter reads. “The goal should be to hold down health costs and increase access to affordable, quality health coverage for all. Unfortunately, the Better Care Reconciliation Act threatens reduced coverage and higher costs for those who continue to have it.”

Must-Read: Nicholas Bagley: Crazy waivers: the Senate bill invites states to gut important health insurance rules: "The bill goes further to grease the wheels for waivers... https://www.vox.com/the-big-idea/2017/6/23/15862268/waivers-federalism-senate-bill-essential-benefits

Must-Read: David Anderson: Reading the BCRA CBO Score: "The Congressional Budget Office is due to release their score on the Senate’s BCRA bill at some point today. Here are a few things to remember as you read the score... https://www.balloon-juice.com/2017/06/26/reading-the-bcra-cbo-score/

Must-Read: Benjamin D. Sommers, Atul A. Gawande, and Katherine Baicker: Health Insurance Coverage and Health—What the Recent Evidence Tells Us: "Perhaps no research question better encapsulates this policy debate than, 'Does coverage save lives?... http://www.nejm.org/doi/full/10.1056/NEJMsb1706645#.WUriDI_R7Z4

(2007): An Unrealistic, Impractical, Utopian Plan for Dealing with the Health Care Opportunity http://www.bradford-delong.com/2007/06/dealing_with_th.html: Felix Salmon deploys me as a weapon in an internecine struggle with his fellow Portfolio magazine writer Russ Mitchell Kevin Maney by blogging a piece of our coffee yesterday at Strada, at the corner of Bancroft and College, in Berkeley:

From June 3, 2007I Like Barack Obama's Health Care Plan http://delong.typepad.com/sdj/2007/06/i_like_barack_o.html: FT.com / Comment & analysis: It is an iron law of American politics that Democratic party politicians who propose relatively detailed healthcare reform plans–as Barack Obama did last Tuesday–get trashed.

Should-Read: David Anderson: Revisiting Cassidy-Collins: "Engagement either leads to burning Senate time if there is no productive grounds for a deal... https://www.balloon-juice.com/2017/05/16/revisiting-cassidy-collins/

Live from the Orange-Haired Baboon Cage: Sarah Kliff: Donald Trump has no idea what health insurance costs: "The Economist asked the president about the fact that many Americans are expected to lose coverage... https://www.vox.com/policy-and-politics/2017/5/11/15624328/trump-health-insurance-costs

No. I do not know why John Cochrane decided to turn himself into a partisan Republican clown back in 2007—willing to say whatever, at that moment, he thinks will win applause from the current crop of Republican politicians; and claiming since, among other things, that:

Should-Read: Craig Garthwaite and John A. Graves: Success and Failure in the Insurance Exchanges: "President Donald Trump and large fractions of the Republican majority... campaigned on an explicit pledge to repeal and replace the ACA...

Weekend Reading: Jacob S. Hacker and Paul Pierson: Republicans’ Obsession with Tax Cuts for the Rich Drove Their Health Care Plan Over a Cliff: "Somehow, Republicans managed to craft a policy that simultaneously...

...raised premiums and out-of-pocket costs, lowered the quality of insurance plans, increased the chances of insurance market death spirals, put new pressure on state budgets, and massively increased the ranks of the uninsured.

Must-Read: The last, italicized, clause in the quote from Ross Douthat below is a lie:

Ross Douthat: Is Obamacare a Lifesaver?: "Now that the Republican Party has beclowned itself on health care... Obamacare repeal... in rubble...

Live from the Republicans' Self-Made Gehenna: Let the record show that Paul Ryan has as little contact with reality as Donald Trump:

Jordan Weissman: Let us now appreciate Paul Ryan’s utter failure as a political leader: "The AHCA... somehow achieved the distinction of being panned by policy experts from the left, right, and center...