Quotulatiousness

April 29, 2017

100 Days of Trump: Three Best and Worst Moments of Presidency So Far

Filed under: Liberty, Politics, USA — Tags: , , , , , — Nicholas @ 04:00

Published on 28 Apr 2017

Reason presents the three worst—and the three best—achievements of President Trump’s first 100 days.
____________________________________________

Third Worst Moment: Replace and Repeal FAIL.

Along with his pledge to build a wall on the southern border and deport illegal immigrants en masse, Trump’s campaign was all about ramming through the “Repeal and Replace Obamacare Act,” which would have cut red tape, gotten rid of the individual mandate, and created a true marketplace for medical insurance. Instead, thanks to the president’s own lack of savvy and GOP dithering, it didn’t even get a proper vote in Congress.

Third Best Moment: The nomination and confirmation of Neil Gorsuch.

The nomination of an intellectually powerful and highly respected jurist to replace the late Antonin Scalia on the Supreme Court demonstrated that President Trump isn’t the flake that many critics figured him to be. Neil Gorsuch might not be libertarian, but he is, in the estimation of Georgetown Law’s Randy Barnett, a serious thinker who believes that government power is and should be limited.

Second Worst Moment: The Country That Bombs Together.

The one action for which President Trump has received bipartisan praise was the bombing of a Syrian government air base to protest the alleged use of chemical weapons by the Assad regime. Even opposition leaders such as Nancy Pelosi and Chuck Schumer signed on to a starkly humanitarian intervention that served no greater purpose than rallying voters here in America.

Second Best Moment: Deregulatory appointees at the FDA, FCC, and EPA.

There’s no question that Trump has picked some terrible cabinet members—Attorney General Jeff Sessions has openly talked about ramping up the war on pot in states where it’s legal, for instance. He also defends asset-forfeiture abuse and has hinted at reviving federal porn prosecutions, too. But picks such as Ajit Pai at the Federal Communications Commission, Scott Gottlieb at the Food and Drug Administration, and Scott Pruitt at the Environmental Protection Agency are serious deregulators who are already starting to prune back regulations that accomplish little but cost taxpayers and innovators lots of time, money, and resources.

Worst Moment: Muslim Travel Ban.

The president has issued two executive decrees calling for a moratorium on travel from several majority-Muslim countries and the suspension of America’s refugee program. Both have been stayed by federal courts and it remains unclear if one will ever become the law of the land. Regardless it’s anti-American to effectively establish a religious test for travelers and migrants here—and it also undermines attempts to reach out to the vast majority of Muslims who are the primary targets of Islamic fundamentalism.

Best Moment: He’s Getting Real.

Every new president enters office thinking they can direct the course of human history via his pen or, in the case of Trump, his Twitter feed. For all his bluster and lack of self-awareness, he’s also learning that the world is more complicated than he reckoned. He’s pushed back deadines for all sorts of projects, from funding for his stupid and useless immigration wall to a timeline for tax reform, which shows that he is living in the real world at least. To the extent he realizes that his best path forward is in cutting economic regulations rather than vilifying immigrants, renegotiating trade deals, and starting new wars, he’ll not only be a better president—he’ll create a better America too.

Written by Nick Gillespie. Produced by Paul Detrick and Alexis Garcia.

March 14, 2017

“Most policy ideas are bad” (especially in US healthcare)

Filed under: Government, Health, Politics, USA — Tags: , , , , , — Nicholas @ 03:00

Megan McArdle says that the best plan the Republicans could come up with to deal with Obamacare is to do nothing, at least in the short-term:

For a policy columnist, “Don’t do that” is the easiest column to write. Most policy ideas are bad. If you simply blindly oppose everything that anyone ever puts forward, you’ll end up being right most of the time.

However, that’s not very useful for politicians. If they just sit around Congress playing tiddlywinks all day, voters will get cranky. Congress is supposed to do things. So, having spent a few days saying unkind things about the Republican health-care plan, it probably behooves me to state what I think they should do.

Well, boy, that’s a hard question. Here’s the thing: For all the unkind words I’ve said, I get the forces that have brought Republicans to this point. As I wrote Thursday, Democrats built a shoddy and unworkable structure out of the political equivalent of concrete: nearly impossible to repair or renovate, and darned expensive to demolish. The task is made even harder by the fact that Democrats currently control just enough votes in the Senate to keep Republicans from passing any sort of clean, comprehensive bill.

[…]

What would I do in this situation? Well, the first thing I’d do is accept, deep in my heart, that there are no great outcomes possible at this point. The second thing I’d do is remember that nothing is always a policy option: If you can’t do something better than the status quo, don’t do anything. It’s what I said to Democrats in 2009, and it’s what I’m saying to Republicans now.

So what would I do to minimize the damage, within the constraints of political reality? Well, I foresee two potential futures for the current status quo. One, the exchanges where individuals buy policies could fail, leaving people unable to buy insurance. Or two, the exchanges don’t fail, and we’re left with an unsatisfactory but still operational system.

In either case, the Republicans’ best option is to wait. Why? Because what they can do now — hastily, without touching the underlying regulations that have destabilized the individual market — is worse than either of those outcomes. The partial-reform structure they think they’ll be able to get through the Senate is likely to make the problems in the individual market worse, not better. And the fact that they’ve tinkered with the program means that Republicans will take 100 percent of the blame.

She also re-iterates her own ideal solution (which she admits wouldn’t fly with the American public):

Longtime readers of my column know that my pet proposal is a radical overhaul of the whole system in which we zero out all the existing subsidies and just have the government pick up 100 percent of the tab for medical expenses that exceed 15 or 20 percent of a family’s adjusted gross income: basically, a single-payer catastrophic-care system for expenses that no one can realistically save for. Let people buy insurance for expenses below that, or, if it’s not too expensive taxwise, let people set aside more money tax-free in Health Savings Accounts. And make some more generous provisions for people closer to the poverty line, such as prefunding Health Savings Accounts for them. That’s the whole program. It fits on a postcard, though the finer details — like which cancer treatments we’re actually willing to pay for — obviously aren’t.

However, this is completely politically infeasible, because voters don’t want genuine insurance, by which I mean a pool that provides financial assistance for genuinely unforeseeable and unmanageable expenses. Voters want comprehensive coverage that kicks in at close to the first dollar of spending, no restrictions on treatments or their ability to see a doctor, nice American-style facilities, and so forth. They are also fond of their health-care professionals and do not wish to see provider incomes slashed and hospitals closed, nor do they want their taxes to go up, or to pay 10 percent of their annual income in premiums. This conflicting set of deeply held views is one major reason that Obamacare — and American health-care policy more generally — has the problems it does.

March 13, 2017

“It’s not really a debate over Obamacare, it’s a debate over Medicaid”

Filed under: Government, Health, Politics, USA — Tags: , , , — Nicholas @ 04:00

Robert Tracinski explains why the Republicans are having such a hard time with their oft-promised “repeal” of Obamacare:

House Republicans have released their proposed measure to “repeal and replace” Obamacare, and the whole enterprise is already losing steam right out of the gate. The measure is too small and incremental, less a repeal of Obamacare and more of a repair of it, keeping numerous basic features intact.

If you want to know why Republicans have bogged down, notice one peculiar thing about the Obamacare debate so far. It’s not really a debate over Obamacare, it’s a debate over Medicaid. That’s because Obamacare mostly turned out to be a big expansion of Medicaid. The health insurance exchanges that were supposed to provide affordable private health insurance (under a government aegis) never really delivered. They were launched in a state of chaos and incompetence, and ended up mostly offering plans that are expensive yet still have high deductibles. Rather than massively expanding the number of people with private insurance, a lot of the effect of Obamacare was to wreck people’s existing health care plans and push them into new exchange plans.

Ah, but what about all those people the Democrats are claiming were newly covered under Obamacare? A lot of them — up to two-thirds, by some estimates — are people who were made newly eligible for a government health-care entitlement, Medicaid. But shoving people onto Medicaid is not exactly a great achievement, since it is widely acknowledged to be a lousy program.

Conservative health care wonk Avik Roy explains why: “[T]he program’s dysfunctional 1965 design makes it impossible for states to manage their Medicaid budgets without ratcheting down what they pay doctors to care for Medicaid enrollees. That, in turn, has led many doctors to stop accepting Medicaid patients, such that Medicaid enrollees don’t get the care they need.” Partly as a result, a test in Oregon found no difference in health outcomes between those with access to Medicaid and those without.

February 3, 2017

QotD: Obamacare, or something like it, was probably inevitable

Obamacare? Well, here’s the truth of the matter: America is addicted to medical care and demands that it be delivered in infinite quantity, in flawless quality, no matter the cost, as long as no one has to pay anything like full price, directly. Unfortunately, the cost does matter, and even if we were willing to devote infinite resources to medicine, we lack the human quality to provide what’s demanded. Short version: [Obama] had to do something; eventually we were going to bankrupt ourselves in the interests of keeping someone’s great-grandmama alive another day or so. I’m not sure what that something was, mind you, and I am pretty sure that Obamacare wasn’t it. But, be fair; he really had to try to do something. So will Donald Trump, and I don’t mean just repeal Obamacare. You may as well get used to the idea.

Tom Kratman, “Free at last! Free at last!”, EveryJoe, 2017-01-23.

October 12, 2016

Jonah Goldberg was having “a case of the Mondays on a Friday”

Filed under: Humour, Politics, USA — Tags: — Nicholas @ 02:00

In last week’s Goldberg File email, Jonah explained how even taking time away from covering the presidential race wasn’t quite as restful as he might have hoped:

I’m having a case of the Mondays on a Friday. I keep poking at the computer screen like an orangutan with a Speak-and-Spell. (For the kids out there, a Speak-and-Spell is what my generation called an iPad.) I’m taking a much-needed vacation day from writing about that whole presidential-election thing. But, when I look at the all the other headlines, I kind of feel like I’m visiting a museum after the zombie apocalypse. It’s not that these things aren’t important, they just seem like they’re from another time.

You have to stare at the painting or the sculpture for a few minutes until you can conjure the memory of why this stuff matters. Take, for example, the dawning realization that Obamacare is like a Claymation version of Wagner’s Der Ring Des Nibelungen staged entirely with characters sculpted out of fecal matter: The mother of all sh*t shows.

September 15, 2016

Asymmetric Information and Health Insurance

Filed under: Economics, Health — Tags: , , — Nicholas @ 02:00

Published on 23 Sep 2015

In this video, we discuss asymmetric information, adverse selection, and propitious selection in relation to the market for health insurance. Health insurance consumers come in a range of health, but to insurance companies, everyone has the same average health. Consumers have more information about their health than do insurers. How does this affect the price of health insurance? Why would some consumers prefer to not buy health insurance at all? And how does this all relate to the Affordable Care Act? Let’s dive in.

November 20, 2015

We’re in “a terrible, horrible, no good, very bad news cycle for Obamacare”

Filed under: Business, Health, USA — Tags: , — Nicholas @ 04:00

Megan McArdle on the plight of some health insurance companies as they try to offer healthcare policies and still make some sort of profit in the current American market:

… UnitedHealth abruptly said it expected to lose hundreds of millions of dollars on its exchange policies in 2015 and 2016, and would be assessing whether to pull out of the market altogether in the first half of next year.

This was part of a terrible, horrible, no good, very bad news cycle for Obamacare; as ProPublica journalist Charles Ornstein said on Twitter, “Not since 2013 have I seen such a disastrous stream of bad news headlines for Obamacare in one 24-hour stretch.” Stories included not just UnitedHealth’s dire warnings, but also updates in the ongoing saga of higher premiums, higher deductibles and smaller provider networks that have been coming out since open enrollment began.

It now looks pretty clear that insurers are having a very bad experience in these markets. The sizeable premium increases would have been even higher if insurers had not stepped up the deductibles and clamped down on provider networks. The future of Obamacare now looks like more money for less generous coverage than its architects had hoped in the first few years.

But of course, that doesn’t mean insurers need to leave the market. Insurance is priced based on expectations; if you expect to pay out more, you just raise the price. After all, people are required to buy the stuff, on pain of a hefty penalty. How hard can it be to make money in this market?

What UnitedHealth’s action suggests is that the company is not sure it can make money in this market at any price. Executives seem to be worried about our old enemy, the adverse selection death spiral, where prices go up and healthier customers drop out, which pushes insurers’ costs and customers’ prices up further, until all you’ve got is a handful of very sick people and a huge number of very expensive claims.

Some commentators, including me, worried a lot about death spirals in the early days of the disastrous exchange rollout. Some commentators, also including me, have eased off on those fears in recent years. Why the change? Because when the law was passed, I was mostly focused on whether the mandate penalty would be enough to encourage people to buy insurance. Over time, as the exchanges evolved, the subsidies, and the open enrollment limitations, started to look a lot more important than the penalty.

[…]

An earnings call like today’s can also be a bargaining tactic. Health insurers are engaged in a sort of perpetual negotiation with regulators over how much they’ll be allowed to charge, what sort of help they’ll get from the government if they lose money, and a thousand other things. Signaling that you’re willing to pull out of the market if you don’t get a better deal is a great way to improve your bargaining position with legislators and regulatory agencies.

That said, strategic positioning is obviously far from the whole story, or even the majority of it. UnitedHealth really is losing money on these policies right now. It really is seeing something that looks dangerously like adverse selection. And frankly, there’s not that much the company can get out of regulators at this point, because the Congressional Republicans have cut off the flow of funds. So while Obamacare certainly isn’t dead, or certain to spiral to its death, it’s got some very worrying symptoms.

June 30, 2015

The Supreme Court and the rule of law

Filed under: Law, Liberty, Politics, USA — Tags: , , , — Nicholas @ 04:00

At Ace of Spades H.Q., Weirddave explains why — even if you are in favour of Obamacare continuing in its current form — you should be worried that the United States Supreme Court made a huge mistake with the ruling that kept Obamacare alive:

… If it had gone the other way, God knows Congress would have fallen all over itself to to reinstate the subsidy. No, what was so gobsmackingly amazing about the decision was that it was justified on the basis of “intent”. 6 out of 9 justices ignored the black letter written word of law in favor of “intent”

So why is this important? Well, let’s start by asking a simple question: Why has the USA been so prosperous? Expand the scope of the question: Historically, why has the Anglosphere been so successful? If one views all of the countries in the Anglosphere as branches growing off of a British trunk, underneath all of them, providing sustenance and support is one common root:

Rule of Law

Rule of Law is a concept that goes back to Greco-Roman times and earlier. The Bible introduces some Deuteronomic provisions to constrain the king that are perhaps the earliest iterations of the concept. Plato advocated a benevolent monarchy, placing his hopes on the willingness of the king to obey the law, Aristotle firmly rebuked him for such a Utopian concept. Things really got rolling in 1215 with the Magna Carta which limited the power of King John to act unilaterally. Samuel Rutherford turned traditional wisdom on its head with Lex, Rex (“The law is king” as opposed to the traditional Rex, Lex, “The king is law”) Locke discussed the concept in great detail, and the Founding Fathers of the US kept the concept as their guiding star as they wrote the Constitution. In every case, as the concept evolved, society became more prosperous, more just and more stable.

And then along came John Roberts.

So what is Rule of Law? Simply put, Rule of Law means that the laws apply to everyone equally. A law is written. It says what it says, and everyone must obey it. No exceptions. The law applies to everyone, regardless of social status, political position, wealth, situation. The law says that one may not drive drunk. If someone is pulled over and they blow 1.5, it doesn’t matter if they were really sad because their grandfather just died, or if their mother ruled Bartertown. They broke the law, they are arrested and tried. (I do realize that real life isn’t quite as straightforward and often times position, power or wealth DO determine how laws are applied in individual cases, but we’re talking theory here). Rule of Law creates a level playing field for everyone.

Real life example: You want to set up a toilet paper factory. You can set it up in America, where a codified set of laws protects your property rights and sets legal limits on what the government can do to you, or you can set up shop in Venezuela where what you build belongs to a corrupt government and can be taken from you at anytime. Where do you build your factory?

Exactly, and that’s why Wal-Mart carries dozens of different types of toilet paper and they are wiping their asses with pine cones in Caracas.

February 22, 2015

Obamacare’s externalities

Filed under: Economics, Health, USA — Tags: , , , — Nicholas @ 03:00

Megan McArdle on just what externalities are and why we pay attention to them:

For those who might not know the term, “externality” is economist-speak, and it means about what it sounds like: an effect that your action has on others. An externality can be positive or negative, and obviously, we as a society would like to have as many as possible of the former and as few as possible of the latter. In other words, “Your right to swing your fist stops at the end of my nose.”

I’m a libertarian, and libertarians love talking about externalities. They give us a (relatively) clear way to define what are and are not legitimate scopes of public action. Whatever you’re doing in the privacy of your own bedroom with another consenting adult is really none of my business, even if I think you oughtn’t to be doing it. On the other hand, if you’re breeding rats and cockroaches in there, and they’re coming through the shared wall of our respective row houses, then I have the right to get the law involved.

Framing things as “externalities” is therefore a good way to get a libertarian, or someone who leans that way, on your side. And such frames have come up over and over in the debate over Obamacare, which has been variously justified by the cost to the state of emergency room care; the cost to society of free-riding young folks who don’t buy insurance until they get sick; the public health cost of people who don’t go to the doctor and get really, expensively sick; an unhealthy workforce that is less productive; and the cost to friends and relatives who have to chip in to cover uninsured medical expenses.

I didn’t find any of those arguments particularly convincing. The third can just be dispensed with on the grounds of accuracy: In general, preventive medicine does not save money. Oh, it may save money in the particular case of someone whose diabetes or cancer went long undiagnosed. The problem is, you can’t just look at the cost of sick folks who would have been a lot cheaper to treat if their conditions had been caught earlier. You also have to include the cost of all the healthy people you had to screen in order to catch that one case of disease. And with limited exceptions, the cost of screening the healthy generally outweighs the cost of treating the chronically ill. Now, you can certainly argue for preventive care on other grounds — for example, that it makes people healthier (though even then you have to add the cost of unnecessary medical procedures, such as biopsies following a false positive on a blood test, which is why we do not, say, give annual mammograms to every American woman). But it’s not generally a money saver, so this particular externality doesn’t exist.

The rest of the arguments have some weight, but in the end, I don’t think they’re weighty enough. Let me explain.

January 10, 2015

The four kinds of healthcare spending

Filed under: Bureaucracy, Business, Economics, Government, Health, USA — Tags: , , , — Nicholas @ 03:00

Megan McArdle explains why healthcare costs more than you think it should:

Milton Friedman famously divided spending into four kinds, which P.J. O’Rourke once summarized as follows:

  1. You spend your money on yourself. You’re motivated to get the thing you want most at the best price. This is the way middle-aged men haggle with Porsche dealers.
  2. You spend your money on other people. You still want a bargain, but you’re less interested in pleasing the recipient of your largesse. This is why children get underwear at Christmas.
  3. You spend other people’s money on yourself. You get what you want but price no longer matters. The second wives who ride around with the middle-aged men in the Porsches do this kind of spending at Neiman Marcus.
  4. You spend other people’s money on other people. And in this case, who gives a [damn]?

Most health-care spending in the U.S. falls into category three. In theory, the people who are funding our expenses — the proverbial middle-aged men in Porsches, except that they’re actually insurance executives and government bureaucrats — have every incentive to step in, cut up the charge cards, and substitute a gift-wrapped box of Hanes briefs with the comfort-soft waistband. In practice, legislators frequently intervene to stop them from exercising much cost-control. The managed care revolution of the 1990s died when patients complained to their representatives, and the representatives ran down to their offices to pass laws making it very hard to deny coverage for anything anyone wanted. Medicare cost-controls, such as the famed Sustainable Growth Rate, fell prey to similar maneuvers. The only system that exhibits sustained cost control is Medicaid, because poor people don’t vote, or exit the system for better insurance.

The result is a system where everyone complains that we spend much too much on health care — and the very same people get indignant if anyone suggests that they, personally, should maybe spend a little bit less. Everyone wants to go to heaven — but nobody wants to die.

Unfortunately, this is what cost-control actually looks like, which is to say, like people not being able to spend as much on health care. Oh, to be sure, we could achieve this end differently — instead of asking patients to pay a modest share of their own costs (the article suggests that this amount is less than 10 percent, in the case of Harvard professors) — we could simply set a schedule of covered treatment, and deny patients access to off-schedule treatments, or even better, not even tell them that those treatments exist. But people don’t like that solution either, which is why medical dramas are filled with rants about insurers who won’t cover procedures, and the law books are filled with regulations that sharply curtail the ability of insurers to ration care. And the third option, refusing to pay top-dollar for care, would be a bit tricky for Harvard to implement, given that they run exactly the sort of high-cost research facilities that help drive health-care costs skyward. Nor do I really think that the angry professors would be mollified by being given a cheap insurance package that wouldn’t let them go see the top-flight specialists their elite status now entitles them to access.

Instead, they persist in our mass delusion: that there is some magic pot of money in the health-care system, which can be painlessly tapped to provide universal coverage without dislocating any of the generous arrangements that insured people currently enjoy. Just as there are no leprechauns, there is no free money at the end of the rainbow; there are patients demanding services, and health-care workers making comfortable livings, who have built their financial lives around the expectation that those incomes will continue. Until we shed this delusion, you can expect a lot of ranting and raving about the hard truths of the real world.

December 14, 2014

Jonah Goldberg on the Gruber hearings

Filed under: Government, Media, Politics, USA — Tags: , , — Nicholas @ 00:03

In this week’s Goldberg File, Jonah Goldberg talks about the show Jonathan Gruber put on in front of some Washington political types:

I learned from Twitter this morning that Gustave Flaubert, born this day in 1821, said, “The art of writing is the art of discovering what you believe.” So, as Jay-Z says every morning he enters a music studio and as Joe Biden says every time President Obama gives him a fresh 64-pack of crayons, “Let’s make some art, bitches.”

Let’s start with Jonathan Gruber. I have to say I was disappointed by the hearings. Oh, sure, it was good theater-as-human sacrifice of the sort Washington does so well (though I am glad they stopped short of rectal rehydration).

But this was one of those moments where they really could have put the system on trial. Gruber’s consistent answer was that he’s a shabby, shallow, little man who belittles others, including the American people, to make himself look good. “I tried to make myself seem smarter by demeaning others.”

In almost every exchange, Gruber fell back on language you’d expect from a stockbroker tied up in an S&M dungeon. I did it because I am a flea! A worm! I am no master of the universe, I am nothing! Punnnniissshhh meee!

All that was missing were some riding-crop and melted-candle-wax welts, and maybe a shorn scrotum. But, hey man, it’s a defense.

But it’s not a good one. You can blame your arrogance for calling the American voters stupid, but you can’t blame your arrogance for claiming that the bill was designed to hide taxes and deceive the public. If I stab someone 34 times, the jury might want to hear about my arrogance, but whether I’m arrogant or humble, it doesn’t change what I did — and apologizing for it doesn’t clarify where the body is buried.

Gruber’s strategy of emotional self-abasement was very clever because it distracted from the central arguments of fact.

[…]

As for Gruber, he said this week that he wasn’t an architect of Obamacare. And yet, for several years he let the New York Times, The New Republic, PBS, and countless other media outlets describe him as exactly that. That label was of great financial value to him. But it was probably of greater social, psychological, and professional value. And that is probably why he seems to have not once taken the time to ask them to stop calling him that. Gruber is of a class of people who take great satisfaction from the belief that they are not only smarter and better than normal Americans, but that their superiority entitles them to manipulate the public and system in whatever way they think necessary.

There’s another reason Gruber never corrected anybody when they described him as an architect of Obamacare: Because it’s true!

Which leads to another important point: Gruber’s a huge, monumental, Brobdingnagian liar.

To believe his testimony before Congress is to believe that on one occasion after another, he baldly lied over and over again to his peers, colleagues, students, and friends. Darrell Issa sort of gets at this here at the end of Gowdy’s interrogation when he asks Gruber, “Did anybody come up to you and tell you that what you were saying was inappropriate?”

That’s an interesting question and tells you a lot about the sovereign contempt the expert class has for the American people. But a better question would be, “Why didn’t anybody correct you on your factual claims? Or simply say ‘What you’re saying isn’t true’?” Gruber was on panels with other health-care experts. The audiences were full of people who were deeply informed about Obamacare and all its details. And yet no one said, “Hey, that’s not the way it happened.” Why? Because Gruber was telling the truth when he said they had to deceive the American people. And before you ask me what proof I have, I would like to direct you to the fact that Barack Obama deceived the American people over and over and over again when he said things like “You can keep your doctor” and “You can keep your insurance” etc. (and not one liberal journalist cheerleader for Obamacare ever felt compelled to push back on this obvious lie). Are we really so stunned that the same president might be willing to play accounting games with the CBO?

Sure maybe Gruber exaggerated his role or involvement. Maybe he embellished this or that. But you can’t exaggerate a lie; you can only exaggerate the truth. For years he told the truth to anyone who would listen, and now that it’s politically problematic he says it was all a lie.

So we’re forced to choose: Was he lying when talking to countless audiences full of peers, colleagues, and experts, or was he lying in front of Congress in order to save his team any further embarrassment and preserve a law he’s sincerely proud of (because he was an architect of it)? Personally, I think you’d have to be too stupid to beat Joe Biden at tic-tac-toe to think the “real” Gruber testified before Congress this week. But whichever side you come down on this question, one thing has been established: He’s a huge liar.

November 23, 2014

Working and middle class pushback against Obamacare

Filed under: Health, USA — Tags: , , — Nicholas @ 11:20

At Mother Jones, Kevin Drum looks at some of the reasons Obamacare is not being embraced by the working and middle classes the way many expected:

Obamacare winners and losersHere’s an interesting chart that follows up on a post I wrote a few days ago about Democrats and the white working class. Basically, I made the point that Democrats have recently done a lot for the poor but very little for the working and middle classes, and this is one of the reasons that the white working class is increasingly alienated from the Democratic Party.

I got various kinds of pushback on this, but one particular train of criticism suggested that I was overestimating just how targeted Democratic programs were. Sure, they help the poor, but they also help the working class a fair amount, and sometimes even the lower reaches of the middle class. However, while there’s some truth to this for certain programs (unemployment insurance, SSI disability), the numbers I’ve seen in the past don’t really back this up for most social welfare programs.

Obamacare seems like an exception, since its subsidies quite clearly reach upward to families in the working and middle classes. Today, however, Bill Gardner points me to a Brookings paper from a few months ago that suggests just the opposite. The authors calculate net gains and losses from Obamacare, and conclude that nearly all its benefits flow to the poor. If I interpolate their chart a bit, winners are those with household incomes below $25,000 or so, and losers are those with incomes above $25,000.

August 12, 2014

Obamacare and the Tea Party

Filed under: Politics, USA — Tags: , , , — Nicholas @ 08:33

Megan McArdle on the direct relationship between the implementation of Obamacare and the rise of the Tea Party:

I think liberals really do not understand emotionally the extent to which the Tea Party was created by the Affordable Care Act and the feeling that its government was simply steamrolling it. From the Tea Party’s perspective, you had an unpopular program that should have died in the same way, and for the same reasons, that Social Security privatization did: because sensible politicians saw that, no matter how ardently they and their base might desire it, this was out of step with what the majority of the country wanted (and no, you cannot rescue the polls by claiming that the only problem with the law was that it wasn’t liberal enough; when you dig down into what people mean when they say that, the idea that there was ever a majority or a plurality that was secretly in favor of Obamacare collapses).

The rage was similar to what progressives felt as they watched George W. Bush push the country into a war in Iraq. That defined and animated the anti-war movement (which is why said movement collapsed when Bush left office, and not, say, when Bush agreed to a staged withdrawal of our forces). Yes, those people would still have hated Republicans, even if there had been no Iraq War. But they would not have been as passionate, as organized or as powerful without it.

Liberals tend to write off this anger as racism, as irrational hatred of Barack Obama, or as perverse joy in denying health care to the poor, but at its root, it’s the simpler feeling that your country is making a mistake and you can’t stop it because the people in charge are ignoring the obvious. Yes, a lot of money and energy was poured into the Tea Party by rich backers, but rich backers cannot create a grassroots campaign unless the underlying passion is there in the voters (paging Karl Rove and Crossroads). The Obama administration created that passion with Obamacare.

[…] I’ve written before about how my Twitter feed filled up with comparisons to 1932 the night that Obama took the presidency, and it’s quite clear to me that the Obama administration shared what you might call delusions of FDR. It thought that it was in a transformative, historical moment where the normal rules of political caution didn’t apply. The administration was wrong, and the country paid for that.

May 23, 2014

He was for the Veterans Health Administration before he was against it

The Wall Street Journal‘s James Taranto rounds up some amusing-in-hindsight bloviations by Paul Krugman about the efficiencies of the Veterans Health Administration:

There was no ObamaCare in January 2006, when former Enron adviser Paul Krugman wrote this:

    I know about a health care system that has been highly successful in containing costs, yet provides excellent care. And the story of this system’s success provides a helpful corrective to anti-government ideology. For the government doesn’t just pay the bills in this system — it runs the hospitals and clinics.

    No, I’m not talking about some faraway country. The system in question is our very own Veterans Health Administration, whose success story is one of the best-kept secrets in the American policy debate.

The “secret” of the VA’s “success,” Krugman argued, “is the fact that it’s a universal, integrated system.” That saves on administrative costs and allows for efficient record-keeping. Krugman acknowledged that the VA had a history of mismanagement and mediocre care, until “reforms beginning in the mid-1990’s transformed the system.” But wait. Hasn’t it been a universal, integrated system all along? Maybe the secret is something else. At any rate, the Phoenix revelations suggest it’s the system’s failures that are being kept secret.

Krugman lamented that his argument “runs completely counter to the pro-privatization, anti-government conventional wisdom that dominates today’s Washington.” That was 2006, remember, when Republicans had the White House and both houses of Congress. If Krugman is to be believed — a big “if,” to be sure — the Bush administration did a far better job running the VA than the Obama administration is doing now. Which reminds us of something Waldman wrote: “There’s an old saying that when they’re out of office, Republicans argue that government is inefficient and incompetent, and when they get in office, they set about to prove it.”

Krugman concluded that 2006 column as follows:

    Ideology can’t hold out against reality forever. Cries of “socialized medicine” didn’t, in the end, succeed in blocking the creation of Medicare. And farsighted thinkers are already suggesting that the Veterans Health Administration, not President Bush’s unrealistic vision of a system in which people go “comparative shopping” for medical care the way they do when buying tile (his example, not mine), represents the true future of American health care.

Good Glitches,” anyone?

Krugman managed to get two more columns out of the glorious VA. One, in September 2006, also damned Medicare Advantage and complained that the administration opposed the idea of letting elderly vets use Medicare benefits at VA hospitals:

    “Conservatives,” writes Time, “fear such an arrangement would be a Trojan horse, setting up an even larger national health-care program and taking more business from the private sector.”

    Think about that: they won’t let vets on Medicare buy into the V.A. system, not because they believe this policy initiative would fail, but because they’re afraid it would succeed.

OK, but think about this: According to The-Military-Guide.com, “if you’re eligible for any level of VA care, whether it’s high-priority or low-priority, you’re no longer eligible for ACA exchange subsidies.” (ACA is an abbreviation for PPACA, in turn an abbreviation for the Patient Protection and Affordable Care Act, ObamaCare’s official title.) There are worse things than being excluded from ObamaCare, of course — but the VA may be one of them.

April 6, 2014

Obamacare, viewed from a distance

Filed under: Government, Health, Politics, USA — Tags: , , , — Nicholas @ 09:16

Peggy Noonan attempts to look at Obamacare apart from the daily battles over details:

As I say, put aside the argument, step back and view the thing at a distance. Support it or not, you cannot look at ObamaCare and call it anything but a huge, historic mess. It is also utterly unique in the annals of American lawmaking and government administration.

Its biggest proponent in Congress, the Democratic speaker of the House, literally said — blithely, mindlessly, but in a way forthcomingly — that we have to pass the bill to find out what’s in it. It is a cliché to note this. But really, Nancy Pelosi’s statement was a historic admission that she was fighting hard for something she herself didn’t understand, but she had every confidence regulators and bureaucratic interpreters would tell her in time what she’d done. This is how we make laws now.

Her comments alarmed congressional Republicans but inspired Democrats, who for the next three years would carry on like blithering idiots making believe they’d read the bill and understood its implications. They were later taken aback by complaints from their constituents. The White House, on the other hand, seems to have understood what the bill would do, and lied in a way so specific it showed they knew exactly what to spin and how. “If you like your health-care plan, you can keep your health-care plan, period.” “If you like your doctor, you can keep your doctor, period.” That of course was the president, misrepresenting the facts of his signature legislative effort. That was historic, too. If you liked your doctor, your plan, your network, your coverage, your deductible you could not keep it. Your existing policy had to pass muster with the administration, which would fight to the death to ensure that 60-year-old women have pediatric dental coverage.

[…]

The program is unique in that the bill that was signed four years ago, on March 23, 2010, is not the law, or rather program, that now exists. Parts of it have been changed or delayed 30 times. It is telling that the president rebuffed Congress when it asked to work with him on alterations, but had no qualms about doing them by executive fiat. The program today, which affects a sixth of the U.S. economy, is not what was passed by the U.S. Congress. On Wednesday Robert Gibbs, who helped elect the president in 2008 and served as his first press secretary, predicted more changes to come. He told a business group in Colorado that the employer mandate would likely be scrapped entirely. He added that the program needed an “additional layer” or “cheaper” coverage and admitted he wasn’t sure the individual mandate had been the right way to go.

Finally, the program’s supporters have gone on quite a rhetorical journey, from “This is an excellent bill, and opponents hate the needy” to “People will love it once they have it” to “We may need some changes” to “I’ve co-sponsored a bill to make needed alternations” to “This will be seen by posterity as an advance in human freedom.”

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