Pragmatism and pre-negotiations

In comments to the post on pragmatic evolution of US health policy on Monday, The Question raised a point that I want to respond to:

on health care why do we always have to pre-negotiate with ourselves and have ourselves primed to accept half a loaf? I am so tired of being sensible when there is no gorram reward. If loudly shouting the most extreme thing we want gets us even half what the republicans have gotten out of it why the hell not??

I want to raise an empirical point and then a broader political/policy point that explains my thought process.

First, empirically, what has “shouting the most extreme thing” gotten Republicans?

It has gotten them power.

What have they done with it so far? In 2009, Democrats at this point had a smaller functional majority in the Senate and a slightly larger majority in the House than the Republicans have today. Democrats had passed and signed into law the stimulus, CHIP re-authorization, Lily Ledbetter, and the Dodd-Frank CARD ACT by now.  They were grinding their way through what would become the ACA.

What have the Republicans accomplished as of today? Read more



Things were bad but things got changed

Ultimately, the reason I can’t get with the whole Democrats are neoliberal shills thing is shit like this:

As legislators and the executive branch renew their efforts to repeal and replace the Affordable Care Act this week, they might want to keep in mind a little-known financial consequence of the ACA: Since its adoption, far fewer Americans have taken the extreme step of filing for personal bankruptcy.

Filings have dropped about 50 percent, from 1,536,799 in 2010 to 770,846 in 2016 (see chart, below). Those years also represent the time frame when the ACA took effect. Although courts never ask people to declare why they’re filing, many bankruptcy and legal experts agree that medical bills had been a leading cause of personal bankruptcy before public healthcare coverage expanded under the ACA. Unlike other causes of debt, medical bills are often unexpected, involuntary, and large.

The whole fucking point of the Democratic party is to help with situations like this. Would single payer be better? Of course. But 750K fewer bankruptcies is a big fucking deal, and we all owe Obama and Democrats a big thanks for passing ACA. People got voted out of office for supporting it, and Obama’s favorability took a hit for passing it. But they did it anyway because it was the right thing to do.

Update. The best thing we can do to preserve ACA is win a couple special elections. You can give to Rob Quist who’s running for the House seat in Montana, here.

Goal Thermometer



Good news everybody

National healthcare spending is significantly (~10%) below 2010 projections:

And people are less stressed about being able to pay for a medical bill:

Why I was told that was Unpossible

Open thread



Good news everybody

The interesting thing to me in this chart besides the final outcome is that the introduction and proliferation of government sponsored insurance after 1980 to 2010 basically was sufficient to replace 1:1 declining employer sponsored coverage and not expand coverage. Legacy Medicaid picked up more responsibility, Medicare picked up more members, CHIP was a brand new program that has covered a lot of kids. But all of those programs were effectively either status quo keepers on a population basis or slowed the rate of uninsurance growth.

There are three major challenges left.

  • Reduce uninsured rate to under 2% (Massachusetts is damn close to that now)
  • Increase the value of the coverage so that it is far more useful to more people
  • Continue to bend the cost curve so that total national healthcare costs grow at or under the rate of nominal economic growth.

 



Good news everybody

Now talk amongst yourselves… open thread!



How’s This For A Solution For Mass Incarceration?

Pay folks decently?

Here’s a new report that concludes, as The Washington Post reports, that:

..raising the federal minimum wage to $12 an hour could prevent as many as half a million crimes annually, according to a new report from the White House’s Council of Economic Advisers, a group of economists and researchers charged with providing the president with analysis and advice on economic questions. (h/t Washington Monthly)

On the other hand:

…spending an additional $10 billion on incarceration — a massive increase — would reduce crime by only 1 percent to 4 percent, according to the report.

William_Hogarth_018

More (and, dear FSM, better) police would help too, the report suggests.  Here’s a fact I didn’t know:

Research consistently shows that departments with more manpower and technology do a better job of protecting the public, and the United States has 35 percent fewer officers relative to the population than do other countries on average….

Spending an additional $10 billion to expand police forces could reduce crime by as much as 16 percent, they project, preventing 1.5 million crimes a year.

Ultimately, the point being made through the data is that locking lots of folks up is — my gloss here — the mark of prior failures.  Or, if you’ve got the Obama gift for seeing the policy opportunity as well as the yawning need, you’d look at it this way:

In the report, the CEA argues for a broader analysis of the problems of crime and incarceration, touching on subjects that seem unrelated to criminal justice, such as early childhood education and health care. The authors of the report contend that by helping people get by legally, those other elements of the president’s agenda would be more effective in reducing crime than incarceration.

Ya think?

Image: William Hogarth, Prison Scene from A Rake’s Progress, 1732-35



Fundamental checks

Two data points that make me fairly confident of November even in an alternate universes with a mostly sane Republican party:

TPM:

Fifty-percent of Americans approve of Obama’s performance as the country’s chief executive, the highest level since May 2013. This is an uptick from his average approval rating during his seventh year in office, which was 46 percent, according to Gallup.

And the latest unemployment claims filing:

Initial US weekly unemployment claims fell by 18,000 over the week ending on 5 March to reach 259,000, according to the US Department of Labor

We’re at peace, there are jobs, and the incumbent President is reasonably popular.  Those are good fundamentals for any incumbent party.

Open Thread