Saturday, July 6, 2013

What Mattered This Week?

I'm behind in my reading this week, so I'll just go with the jobs report as something that mattered -- not as far as electoral politics is concerned, but for the economy.

For doesn't matter...well, a lot of the stuff about the ACA employer mandate delay is overstated. I don't know if it "doesn't matter," though.

What does you have? What do you think mattered this week?


  1. Uh, didn't some things happen in Egypt that at least may matter? Even if you don't think they do ("the military always had the real power" etc.) I would think it would at least be worth mentioning, if only as something whose significance you think was being exaggerated...

    1. Usually our host only mentions one of many things that he thinks mattered, and allows us to mention the other stuff.

    2. A coup staged by a military that receives significant US funding -- yup, that matters.

    3. What anon said -- I used to try to list all the things that mattered; now I just get it started with one.

      But, yeah, I could have gone for the obvious Egypt one...

  2. One of the interesting aspects of the ACA employer mandate delay is that Ezra Klein got a lot of love for dismissing the delay as a change in a poorly-planned, irrelevant provision. Irrelevant, because as Ezra notes, "...the mandate, as written, affects relatively few employers." He follows that with a Wharton professor noting that only a small fraction of American employers have a) 50 workers, and b) no health care provision.

    Well, sure. Of course, the reason for the penalty is to keep it that way. Romanticized notions of socialized medicine notwithstanding, neither the US govt nor its citizenry can afford world class health care if Corporate America suddenly unburdens itself from its significant share of the cost of health care, in the process potentially dramatically changing Ezra's "small fraction" and, more importantly, seriously f***ing up the country.

    As always, I'm not saying that will happen, nor even that Ezra is stupid, but that's a pretty big elephant in the room to be missed by a guy whose home on the intertubes is appropriately named "Wonkblog". This isn't about Ezra, but rather about how this reminds us that the ACA is so big we're flying blind in a rainstorm, with so much chatter about the rain out there.

    Does it all matter? I'll guess we'll find out, but we probably won't know before we get there.

    1. Hmmmm. I am not so sure that most health-care wonks would agree with you on the "cannot afford" part, CSH. You can easily find all sorts of people on right, left, and center who think the biggest piece of bad luck to befall American health care, or at least the provision of insurance therefor, was the slide into the employer-based system that began in the 1940s. Such people tend to think that the unravelling of the employer-based system is not only a very good thing, but perhaps even a long-term necessity.

      Or is it the "suddenly" part that worries you? I think you would find more support there, just not very many people who think that outcome is likely enough to really worry about. Which does raise an interesting question -- why are you so concerned? Why do you see the employer-based system as being sooooooo much more fragile than most wonks seem to see it? What forces do you see at work that others are discounting?

      For that matter, what do you see as the risk? If the employer-based system unravels, well then, it unravels. Many other countries do fine without such a system, and the US surely could as well. Oh, the political fallout would be spectacular, no doubt, but so what? That's what the political system is for, after all. Is it an economic collapse that worries you? Or are you concerned that the political system is too fragile or too dysfunctional to deal with the crisis? That, ultimately, is a responsibility that rests with the American people. In the face of such a crisis, they will have to empower a government to craft a solution. If they are incapable of doing so -- well, it's a democracy and the American people will, I guess, have to suffer for their failings, which is as it should be.

    2. Anastasios, thanks so much for the detailed reply. Lot to think about, do appreciate the invitation to bloviate (not that the invitation is necessary, but it sure helps).

      First, I'll go back to your recent discussion with Adam, in which Adam protested that the NHS was better than the American system, and you replied, well sure, when total populations are compared, but if you're on the "right" side of the health care moat in the US, your access to service (especially high cost, complex care) is much better than the UK (with the overall result obviously explained by health care being utter shyte for those on the wrong side of the divide in the US).

      That moral hazard, the dramatic moat separating the health care haves and have nots in the US, is the great festering wound underlying the change to ACA and away from employer-provided insurance, which has been the enabler of high quality US health care (or was, until recently). As I see it, there are roughly two ways the ACA can go:

      1) As advertised. The employer-provided system remains mostly intact, with minimal dumping (IIRC, the CBO estimated something like 7%). The people on the right side of the health care moat mostly see their health care undisrupted, while the ACA helps those on the wrong at not-too-terrible a cost. Fingers crossed.

      2) The McKinsey/mass dumping way. IIRC, McKinsey forecasted something like 35% or so of large employers planned to dump their employees on the exchanges. At a certain level: so?

      The problem is the money. If your gold plated health plan is costing your employer 12 K (and you 5 K), and you get dumped, then assuming you make more than $46 K per year, your health care cost is going to jump $12 K after you're dumped (assuming your employer doesn't provide a parting gift).

      Still, so? Can't we just slap a levy on corporate America to get that $12 K per worker back? (That will no doubt sail through Congress!). So what if Joe Ambulatory Hamburger Fox News has to pay $12 K per year extra in health care? That's what the poor people currently trying to contract in the individual market have to pay!

      So here's my conclusion: first, I'm not one to worry terribly about the feelings of Joe Ambulatory Hamburger. But second, I don't at all trust my politicians to react the same way. A massive downgrading of middle America from the priviledge of corporate large group health care to the struggle of individual-type plans (the likely outcome of mass dumping) is a recipe for chaos.

      Sure, life sucks, get a helmet. Hard to say that to millions of furious anonymous Americans.

      Finally, why is no one worried about this? Maybe we're complacent? Been a long time since we've had scary public activism in this country; hopefully it is much longer still.

    3. Probably an unnecessary clarification: the exchange is clearly not an "individual" plan, but the trait it will share with individual plans (for those previously in corporate plans and making more than $46 K) is lack of subsidy. That's what I meant by "individual-type", which reads strangely above.

    4. CSH,

      A massive downgrading of middle America from the priviledge of corporate large group health care to the struggle of individual-type plans (the likely outcome of mass dumping) is a recipe for chaos.

      What is wrong with individual plans?

      Why is it good to tax subsidize the corporate purchase of employee health "insurance?"

      Who do you think is paying for employer-purchased "insurance" if not the employee (in reduced wages?)

      Who does it benefit to have employee "insurance" tied to a specific job? Employers, maybe?

    5. backyard, thanks for the comment, your points are good ones, IIRC Jeff made a similar point about the employee 'paying' for subsidized health care through reduced wages. Potentially, that employee can force an employer who saves several thousand from dumping to give those benefits back in the form of increased wages.

      That may be, and let's hope so. Two cautionary notes: first, an employer that planned to pass the savings back to the employee probably wouldn't plan to dump in the first place, as the administrative headache wouldn't be justified by no net benefit to them.

      Second, and perhaps more dauntingly, there's a heck of a lot of MBAs working at Applebee's in our terrible economy. It doesn't seem therefore like the average employee would have much power to stop their employer from giving them the shiv.

      But I hope you're right.

    6. I think that it depends on how the skilled worker sector of the economy is doing. When your employees are highly trained to do the job you need done, there's a cost associated with hiring a new employee. That cost is invariant whether you lost the employee to illness or because you pissed them off.

      On the other hand, if insurance costs are significantly lower for states like California than they are for business, I can imagine an employer setting a new hire down in front of a computer, having them to choose a plan, and paying for it out of corporate funds. For the employee, the costs are the same. But if a company can save $5K per employee (paying $7K instead of $12K, for example, for a decent plan) EVERY YEAR, I can see it happening.

      To my mind, that could promote movement of corporations to California, or to any other state that's aggressive in their insurance pricing.

    7. CSH,

      Those are certainly valid concerns, and I am usually the last to stick up for the intelligence of either policy makers or corporate leaders. However, this raises another issue. Given that the American health care system per-ACA was untenable over the long term, and probably even the medium term, and given that any action that had a prayer of actually addressing the problems meant taking risks with the employer-based system (in terms of unravelling as in the ACA, or of expense in terms of Clinton or Nixon), what would you see as a better set of safeguards? Higher penalties? Strict mandates like those offered by Nixon in 1974? Just openly canning the whole mess and extending Medicare to all citizens, as in Canada? Monkeying with the tax code the way so-called GOP reformers propose? Any of these things seem to be pretty noxious to either employees, employers, the insurance industry, or all of the above. After all, Obama did not go with the specific provisions of the ACA because either wonks or Democratic activists wanted them (one of the ACA's huge problems is that those groups range from lukewarm to hostile even now) but because in the face of obdurate GOP opposition, he had to go with solutions that would minimize the opposition of current stakeholders. Any attempt to strengthen the employer mandates might well have been the poison that cured the patient by killing him.

    8. Should have read "pre-ACA," not "per-ACA."

    9. Oh, and I guess I should ask this: if Joe Ambulatory Hamburger does get mad, what are you afraid politicians will do? As I said above, in a democracy responsibility does indeed rest in the end with JAH, and it is up to Mr. Hamburger to empower a government to solve the problem. If he doesn't, then Joe must pay the price for his failings and inferiorities (and I do not apologize for that term, as Joe's compatriots in other democracies have navigated worse obstacles). Are you afraid that Joe just isn't up to the task? Or do you fear what he will empower politicians to do?

    10. Anastasios, I certainly would have favored a stiffer penalty, but then I am sure the Obama Administration would have too, but as you note, pressure against that was no doubt severe.

      Which sort of raises another interesting thought: the dumping assumption baked into the ACA by the CBO (7%, IIRC) is smaller than the alarmist, McKinsey scenario, and it is also, conceptually, "small", but that 7% is not - statistically - "minimal".

      So for example, if we were doing a survey to be published in the Journal of Political Science as Hard Science, a 7% likelihood of being dumped would be too high for a publication to conclude that one was (statistically) unlikely to be dumped - assuming that was a decent journal, of course.

      Setting aside the wonkery, even the lowish dumping assumption baked into the legislation (7%) does not represent - in a statistical sense - the employer-based system remaining "intact" (though it is close). The long-winded point being that, while 7% is not a lot conventionally, it is big enough that it is not "small", statistically, which I believe is solid evidence of the corporate resistance you mentioned.

    11. Also, on a lighter note: Joe Hamburger's monogram - that's inspired. Gotta copyright that, as its future is bright indeed.

      I wasn't gonna go here, due to its political incorrectness, but eventually I couldn't resist, and anyway TN channeled these guys (appropriately) on the "Reagan in rock" thread, so why can't I go there inappropriately?

      In a weird, Dan-Brown/Bible-Code/Mysteries-of-the-Universe-innocuously-hidden way, Joe's initials really work, in the context of the first two lines of one of the best, (if also most politically incorrect), alt-rock songs:

      Every day, I get up and pray to JAH,
      And he increases the number of progs by exactly one

      (He allegedly doesn't say progs - but as the Dan Brown/Bible Code crowd knows, if you hear it, its probably real).

      Indeed, the very title of the song is surely a plank in Rupert Murdoch's master plan, no?

      It all starts to come together. Even if there's not a line here that rhymes with anything.

  3. Obama's action gives the lie to Pelosi's statement about passing the bill in order to know what's in it. (It's hard to imagine a better quote to describe how vile the federal government actually is.)

    The bill WAS passed and Obama is simply doing whatever he finds politically expedient, enforcing elements or not at whim. Progs will view this as good governance.


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