What is the conservative plan on health care?

With the Iowa caucuses 48 hours away, poor Ted Cruz just can’t catch a break. His debate performance was lame, his campaign got caught playing Big Brother with voters, and now he – rather than any of his competitors – had to field the killer question on Obamacare.

An Iowa voter confronted him at a town hall and told  the story of the voter’s wife’s brother,  a hard-working self-employed barber who couldn’t afford health insurance until the ACA came along. Then he felt sick, went in for a check-up, and was diagnosed with inoperable late-stage cancer. The voter’s question was straightforward: if you repeal Obamacare, what replaces it for people like my wife’s brother? (Left unspoken: if ACA had passed earlier, the brother-in-law might have lived.)

Cruz expressed ritual sympathy and immediately pivoted to his health-care talking points. The voter pressed for a real answer, but Cruz didn’t have one for him, just as none of his competitors would have had one. No Republican has proposed any actual substitute for the ACA formula of affordable health insurance for everyone who wants it.

Now, there’s an honest conservative/libertarian answer to that voter’s question; I’ve heard it from friends on that side of  the aisle. It goes more or less like this: Continue reading “What is the conservative plan on health care?”

A human being lives there: Grubergate

Jon made some really misguided and condescending comments that fueled the #Grubergate frenzy. So I am both angry with and sad for him today. In the apocalyptic politics of Obamacare, it’s easy to forget that he’s also a good person and a distinguished scholar who is getting the full internet-frenzy gang tackle right now.

Ezra Klein captures well my own sadness:

I’ll offer a slightly smaller final thought here: Gruber increasingly looks like a casualty of Obamacare. He’s become a liability to the law’s supporters — “I don’t know who he is,” said Nancy Pelosi, who had cited Gruber’s analyses during the health-care debate — and a villain to its opponents. He has been made into the worst comments he ever uttered on tape.

That’s a shame. Gruber tried to make it a better bill than it is. He tried to make what was in it clearer and more known than it was. And then — and this is where all the tapes come from — he traveled the country trying to explain it to people. And Gruber, as is perfectly clear now, was not an experienced political operator who knew how to talk carefully in front of a camera. The lesson other academics will take from his humiliation is that they best stay out of big policy debates, and they had really better make sure they never say anything interesting on tape.

Washington has always done this to people, but it’s happening more frequently, and more viciously, in the age of Twitter and YouTube. And while it makes sense in every individual case, it is, on the whole, bad for American politics. “It’s a healthy world where academics can speak their minds at conferences and the like without their words becoming political weapons in a bigger fight,” writes Tyler Cowen.

Cowen goes on to suggest that “perhaps we should subsidize people who end up looking foolish, rather than taxing them.” We’re not going to do that, of course. But we can at least try to be a bit more generous. We can remember people are more than the most controversial thing we’ve ever heard them say.

I am reminded of Philip Roth’s comments about a much more megawatt and sordid scandal. Roth also advised President Clinton to hang a banner outside the White House: “A human being lives here.” On all sides, we easily forget our humanity and compassion these days. The ecstasy of sanctimony is an ugly thing to see.

How it’s done: Mark Begich campaigns on Obamacare

If the Democrats don’t hang together on Obamacare, they will be sure to hang separately.

As long as the polls show the net favorables for “Obamacare” under water, there will be a temptation for Democrats, especially in Red states, to run away from it. That approach is (1) cowardly (2) wrong and (3) futile.

If people hate the ACA, they’re not going to love Democratic candidates.And if Democrats don’t stand up and brag about about the program’s good points, lazy reporters will keep reporting, “objectively,” that it is a disaster, and low-information voters will believe them. There’s a bit of a collective-action problem here; no one wants to be out of step with everyone else, but it’s also a case of “hang together or hang separately.” The only sane approach for Democrats as group is to be loud and proud about what a great idea it is to protect people from the risks of disease, the vagaries of the job market, the rapacity of some elements of the medical-care system, and the cold-bloodedness of health insurers.

Like this ad from the Mark Begich campaign in Alaska [correction: it’s actually from an independent-expenditure group]:

h/t Martin Longman at Washington Monthly.0 Longman’s piece, about the “hack gap,” is worth reading. I’d add that it applies to politicians as well as pundits.

In case you were wondering: Paul Ryan on health insurance

Paul Ryan fesses up: there’s no way the Republicans can preserve the popular parts of Obamacare.

Paul Ryan admits that the popular parts of Obamacare – guaranteed insurance even for those with pre-existing conditions, allowing people up to 26 coverage under their parents’ insurance, a ban on higher premiums for those working physical-labor jobs – wouldn’t be affordable without the rest of it, including the individual mandate. Ryan’s occasional lapses into honesty aren’t really enough to justify his reputation as a Serious Person; he’s mostly a standard-issue downward class warrior and a master of the Magic Asterisk. But that’s no reason not to be thankful when he does tell the truth. “Repeal and Replace” means, in simple English, “Screw you!”

This is why the politics of Obamacare are likely to turn around over the next few months and years. We’re switching from a situation where status quo bias is on the side of the naysayers to a situation where Ryan and the rest of the wrecking crew have to explain to millions of people why what they have needs to be taken away from them in order to support loopholes for corporations and keep taxes low the top tenth of one percent. That’s the logic behind the orgy of rage and fear to which the right wing has treated us over the past five years. My prediction is that health care will be at worst a wash for the Democrats this fall, and that Hillary Clinton will use it to slaughter whatever sacrificial goat the Republicans put on the altar in 2016.

Employment, Health Insurance and Means Testing

The CBO Budget Outlook (2014-24) is out today, and much of the focus is on their revised estimate of the ACA’s impact on the labor market (Appendix C, pp. 118-27). CBO is projecting that “the ACA will cause a reduction of roughly 1 percent in aggregate labor compensation over the 2017-2024 period, compared with what it would have been otherwise” (p. 117). This is basically CBO’s estimate of the impact of the marginal tax rate on labor income created by the various policy structures of the ACA that Casey Mulligan has written about. As I wrote in this post, you get less of something if you tax it, so if that is not your goal (it is with tobacco taxes, for example) then you are left to decide whether the reduction is worth achieving an alternative goal(s). That can be a difficult question to answer, because you are trading off important things–labor market participation, rates of uninsured, and the system reform provisions of the ACA.

Is reduced labor market participation a sign that we should move away from the structure of the ACA? If yes, to where? Continue reading “Employment, Health Insurance and Means Testing”

Private Score of Senate Republican Health Proposal

Brad Flansbaum sent me a link to a private score of PCARE, the reform plan released on Monday by Republican Sens. Burr, Coburn, and Hatch. I don’t know the Center for Health and the Economy, though I do know several members of their advisory board and many of you will as well. I don’t have my own simulation model to be able to verify these sorts of results, and the CBO is the final word, but I will just assume that a group that has Uwe and Holtz-Eakin on the Board must be somewhat credible. There is much to be learned here, even if you assume this to be an overly optimistic score.

First off, lets just say that the rage machine that has been perfected to argue against the ACA could get plenty cranked up from the these results. There is a breathless Americans for Prosperity Ad running in North Carolina talking about a nice lady losing her doctor in an Obamacare plan, in health policy speak, due to the rise of the narrow network. Yep, this score says PCARE will have a slight increase in persons covered by 2023 compared to the ACA, but most of that arises from a shift of people into narrow network plans. Continue reading “Private Score of Senate Republican Health Proposal”

You want health insurance with terrible customer service? Forget Obamacare–try Blue Cross Blue Shield of Illinois

There’s not much more to my post than the headline: I’ve just concluded my sixth phone call with BCBS of Illinois (having been hung up on the first five times by an automated phone tree which sends you directly to an automated service-satisfaction survey without first giving you any service to be satisfied about). This means I spent the better–or worse–part of two hours trying to find out why BCBS sent me a bill for my January premium I’d already paid on-line.

I went straight to Blue Cross to buy health insurance because I don’t qualify for a subsidy and didn’t see any reason to grapple with–or burden–healthcare.gov. But every time you hear that payments made on the government Website might not be transferring properly to the insurers, please remember that payments made on the Blue Cross Website suffer from the same disability. And while there’s a live chat on Healthcare.gov which at least connects you to a person who can explain the problem, Blue Cross has made sure to keep its product completely untouched by human hands. I finally got through by calling corporate headquarters and explaining first to the corporate operator and then to local customer service and then finally to national customer service (after local stayed on the line with me for ten minutes to assure that national actually picked up) that a bill dated 12/12 should have included an electronic payment made on 12/2, and that no, the bill and my payment hadn’t “crossed in the mail.” In the words of the great Eric Clapton, “How many times must I explain myself ‘fore I can talk to the boss?” though by “Forever Man” I doubt he meant “man with whom you have to stay on hold forever.”

In short (I know, other people’s customer service nightmares are a bore while one’s own is fascinating), everyone who complains about the f***-ups of Obamacare ought to take a second a remember the last time s/he had to deal with a private insurer. In fact, the worst thing about the Affordable Care Act is that it leaves the insurance companies in the picture, and us to their continued tender mercies.

Evidence of safety nets as trampolines

There’s a spike in small-business formation when people become eligible for Medicare and don’t have to fear losing health insurance if they leave their jobs.

Just as James said, people in the U.S. become much more likely to start a small business when they become eligible for Medicare. That’s a like benefit of Obamacare that doesn’t often get mentioned.