Universal coverage is the proper Democratic rallying cry moving forward

Democrats from Joe Manchin to Bernie Sanders are doing a great job uniting in defense of the Affordable Care Act. Moving forward, there is a risk we will form a circular firing squad around support or opposition to single-payer health care. A better approach is to unite around universal coverage, and around various forms of the public option, so that consumers can buy into Medicare or Medicaid if they so choose.

More from me here, in a tome at Democracy Journal.

A missed opportunity to report on the rural opioid crisis

Columnist Salena Zito wasn’t very candid with me in a recent Twitter exchange. That’s annoying. More important, she’s missed a real opportunity to contribute genuine reporting on the rural opioid crisis.

Twitter generally conveys the emotional warmth of a contentious economics seminar without the intellectual rigor. Still, I’ve come to value my Twitter engagements with kindred spirits and others with whom I deeply disagree whose insights I value.

Ms. Zito is one person I hoped to learn from across the usual partisan and ideological lines. She is a conservative reporter and commentator who writes for the Washington Examiner, New York Post, CNN, and other outlets. Ms. Zito is most famous for her aphorism that “the press takes [President Trump] literally, but not seriously; his supporters take him seriously, but not literally.” This is a genuinely valuable insight into how political professionals underestimated Trump’s electoral appeal. (It is also a profound moral evasion, but that’s another matter.)
Continue reading “A missed opportunity to report on the rural opioid crisis”

BCRA and the disability community

I’ve been doing some writing for Slate these days. I wrote a long and profound piece on BCRA and disability here.

Just today, I did a podcast with Jordan Weissmann. I bloviated, but it was fun. I have to raise my podcast game.

The best part was schooling Jordan on BCRA by making analogy to Jay-Z and Rihanna’s relationship woes. Still not sure why he kept laughing when I was trying to make a serious point.

Another Modest Proposal on health insurance

Follow the logic of ACA repeal and ban employer health insurance (irony alert).

I am shocked, shocked to discover that no less than 155 million Americans are forced by employers to take a substantial part of their pay (or the family breadwinner’s pay) in the form of health insurance. Health insurance they have not chosen, but has been forced on them. Republicans cannot be content with the repeal of ACA and the cutting of Medicaid down to size. As Avik Roy points out, Medicare cannot be ignored for long. Nor should the cancer of employer health insurance. The same sound conservative logic points inexorably to its abolition.

The loss of freedom is on a positively Soviet scale. Consider these well-known facts.

  • Employer health insurance covers the healthy and the unhealthy alike, and at the same rates. That’s totally unjust. Why should a 25-year-old trainee who runs a mile every morning, never smokes or drinks, and shops entirely at the farmers’ market, hand over part of her hard-earned pay to subsidise the asthmatic 55-year-old chappie in Accounts who smokes, drinks, never takes any exercise and alternates between McDonalds, KFC and Dominos for his daily injection of cholesterol-, sugar-, and additive-laden food? It’s positively un-American, and removes the vital incentive to make good lifestyle choices.
  • Male employees have as much deducted from their pay as women, and the single as much as those who have children. Nothing wrong with children of course, but it’s a personal choice just like preferring a new car to a holiday in Tahiti, and people should assume the consequences of their actions. If a woman has a child without previously arranging for a husband, that is likewise her lookout.
  • Employer health insurance is a form of bondage that ties the employee to her employer independently of the mutual benefit of a free labour contract. The costs of losing a job include, as they do not in America’s competitors, the loss of health insurance. Many American workers are trapped in jobs they are not suited for, or have gone sour on, through this fear.
  • Employers are also faced with a heavy cost their competitors in other countries do not bear. In a world without employer health insurance, cash wages go up of course. But the employer would still gain on balance: from not keeping on the unhappy workers whose main motive for staying on is assured health cover, and the high administrative costs of running the scheme. Danish businesses don’t employ a team of people in Human Resources to look after employee health, what would be the point?
  • The public policy win comes from bringing back that vital “skin in the game” when individuals buy insurance for themselves. In employee health insurance, it’s not so much a principal-agent problem as the absence of an identifiable principal. Firms know little about health insurance. They buy it because it’s expected by new hires and valued long-serving core staff alike, and everybody else does. They will buy “good enough” and then stop looking. Unleashing the power of the free market to lower prices implies real competition in every sale. This means each individual or family unit must be an agent in a vigorously contested market.

Employer health insurance must go, with the massive tax break transferred to individuals. Some of my more radical libertarian friends think that’s far from enough. All insurance is morally flawed, as it removes the “skin in the game” by spreading risk across large pools. Insurance breeds carelessness. Beyond that, the whole concept of employer and employee is suspect. The Marxists are right, they say, in condemning the wage relationship as servile and alienating: you are not selling something you have made to another, but selling him your very will, accepting a temporary but still abject bondage under which your master controls what you do. In a truly free society, the only employees are women and children naturally subject to the authority of the male head of the family. Should slavery be reintroduced, an idea on which I offer no opinion, it would complete the salutary restoration of the Roman paterfamilias.

We must reluctantly postpone these fascinating debates to another day. For now, Republicans must use their possibly short-lived control in Congress to strike off the tentacles of employer health insurance slowly strangling American business and American freedom.

The “American Employee Freedom in Health Care Act” would be very short. It only needs two operative articles, leaving aside the changes to the tax code.

Article 1. With effect from 1 January 2019, it shall be prohibited for employers to provide health insurance to employees, under pain of a fine of $5,000 for each employee and year of service for which such insurance is provided.

Article 2. The date of entry into force laid down in Article 1 shall be brought forward to January 1 2018 where the employer is a media organization, registered lobbyist, think tank, political party, or other organization engaging in political advocacy or policy analysis as its principal activity, and the employee is a journalist, columnist, presenter, analyst, or regular commentator.

BCRA will probably kill thousands of Americans every year

…And it’s not alarmist or uncivil to say so.

The effects of insurance on mortality are inherently difficult to precisely forecast.
But we have many strong reasons to believe that uninsuring millions of Americans would cause thousands of them to needlessly die every year.

We can debate the magnitude of this effect and how we might measure it. But the burden of proof does not rest with liberals to defend this sensible proposition, nor to prove that the likely harms associated with BCRA will definitely come to pass. Rather, the burden resides with BCRA supporters to show why we can be confident that snatching coverage from low-income people will not bring serious harm. Bill supporters have not come close to meeting this standard.

At least that’s what I argue in my second piece for Slate.

After Trumpcare, Medicare Part M

Here’s a thought: as soon as we defeat Trumpcare, Democrats in both houses introduce Medicare Part M (for Middle-Aged), covering people ages 50-64.

A. It’s good politics:

1. These are the people who were going to be hit the hardest by Trumpcare premium increases. Offer them a better deal and they’ll support us–and people this age vote!

2. It sounds more moderate than Medicare for All, while also making a solid step closer to single-payer, which the Republicans have managed to make sound like pie-in-the-sky socialism with a side order of end-of-the-world.

B. It’s good policy:

1. These are the sickest people in the Obamacare exchanges–move them out of the pools and premiums go down.

2. BUT they’re healthier than most people now on Medicare: put them into that risk pool and the premiums go down there, too.

DON’T believe Trump when he says Obamacare is collapsing.

DON’T believe pundits who say the Democrats have no platform/positions: this plus increased minimum wage plus let’s get out of Afghanistan is platform a-plenty.

In remission and taking names

I was in DC on Thursday for some health advocacy, when a topless rather Goth young(er) woman ran up to me and wanted to give a hug. You’ll have to take my word for it that one kindof gets used to this sort of thing as a Twitter celebrity.* Still, I hesitated for a moment, and she said: “Thank you for the work you do,” and she held up her sign (see below fold).

She is a cancer survivor. She is now protesting the Senate health bill, given her preexisting condition and the rest. She’s in remission after punishing chemotherapy and other trials. She was loaded for bear like many people on this list. “It’s a little uncomfortable to see someone like this,” she said. But not as uncomfortable as chemo and surgery.

“You do you,” I said. “And be well.” We went our separate ways.

*Comment meant to be taken seriously not literally.
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Three obvious but important thoughts on the Scalise shooting.

Three obvious but important points.

1. Most important, very best to Rep. Scalise and to others wounded in this atrocity. Very best to Capitol Police officers David Bailey and Crystal Griner. The bravery and sacrifice of Capitol Police prevented a tragedy from being much worse. And best wishes for a full recovery to Zack Barth and Matt Mika.

If you want to gain a small sense of what these individuals and their families are going through, you might peruse photographer Kathy Shorr’s beautiful recent book, Shot. Shorr’s book provides portraits and brief stories of 101 survivors of gun violence. Shorr’s photographs convey the lacerating damage firearms inflict. Shown below is Chicagoan Ondelee Parteet.  He was shot in the face by a 14-year-old boy after an incident at a party.

Ondelee Parteet, by Kathy Shorr

Continue reading “Three obvious but important thoughts on the Scalise shooting.”

Senator McCaskill calls out AHCA’s shambolic legislative product and process

Senator McCaskill blasted Republicans yesterday over the lack of hearings or basic transparency in Republicans’ effort to ram the AHCA through the Senate.

As Jonathan Chait and others note, Republicans have done everything to pass AHCA they falsely accused Democrats of doing to pass the Affordable Care Act eight years ago. ACA included dozens of hearings over many months, the Senate HELP committee and the Senate Finance committee adopted dozens of Republican amendments. They would have adopted many more, had Republicans not made the basic strategic decision to drag out the process and then simply bloc vote against ACA. AHCA is obviously a slipshod and rushed legislative product, being rammed through with no hearings, enacted in the House before a proper CBO score. In the rush to reach 50-percent+1, I expect some staffer’s girlfriend will be accidentally enacted into law.

A great irony of this process: President Obama paid a heavy political price because he entered the process with the avowed hope of bringing people together. He specifically incentivized Republican intransigence because he ran as someone who could heal Washington and bring people together. Whatever else happened, Republicans were determined that President Obama never be the person who brought people together. Democrats paid a policy price, too, making key concessions to Republicans and to their own party’s most conservative members. The Democratic party base probably won’t tolerate a similar strategy again.

Republicans never promised to engage Democrats in the process. And they are bluntly ramming things through. They won’t pay a particular political prices for that. But they will pay a heavy price for producing a substandard product that will hurt millions of people.