When Grown Ups Are In Charge

Here’s President Obama, writing in SCOTUSblog* on what he’ll look for in a Supreme Court nominee (h/t Washington Monthly):

First and foremost, the person I appoint will be eminently qualified.  He or she will have an independent mind, rigorous intellect, impeccable credentials, and a record of excellence and integrity.  I’m looking for a mastery of the law, with an ability to hone in on the key issues before the Court, and provide clear answers to complex legal questions.

Second, the person I appoint will be someone who recognizes the limits of the judiciary’s role; who understands that a judge’s job is to interpret the law, not make the law.  I seek judges who approach decisions without any particular ideology or agenda, but rather a commitment to impartial justice, a respect for precedent, and a determination to faithfully apply the law to the facts at hand.

But I’m also mindful that there will be cases that reach the Supreme Court in which the law is not clear.  There will be cases in which a judge’s analysis necessarily will be shaped by his or her own perspective, ethics, and judgment.  That’s why the third quality I seek in a judge is a keen understanding that justice is not about abstract legal theory, nor some footnote in a dusty casebook.  It’s the kind of life experience earned outside the classroom and the courtroom; experience that suggests he or she views the law not only as an intellectual exercise, but also grasps the way it affects the daily reality of people’s lives in a big, complicated democracy, and in rapidly changing times.  That, I believe, is an essential element for arriving at just decisions and fair outcomes.

David_Gilmour_Blythe_-_Justice_-_Google_Art_Project

Also — just in case you were worrying (I wasn’t and am not) that President Obama might take seriously for a moment any suggestion that he should punt on this choice, here’s all you need to know:

The Constitution vests in the President the power to appoint judges to the Supreme Court.  It’s a duty that I take seriously, and one that I will fulfill in the weeks ahead.

I will so miss this man.

*POTUS blogging FTW!

Image:  David Gilmour Blythe, Justicec. 1860



Good news everybody

The CDC  has released their initial 2015 uninsured population counts.  Good news, for all residents of the US in the US through September 2015.  Remember, this percentage will go down a bit more as Montana and Alaska are expanding Medicaid and the 2016 Open Enrollment period pulled in more people.

 

CDC 2015 uninsured rate

These numbers are a bit lower than Gallup and other sources because this data set includes kids and the elderly.  Both of those groups tend to have a higher insurance rate because there are more government programs aimed at those two populations.  Working age adults have a slightly higher than national average uninsured rate.








The curve is bending

The cost curve is bending to a lower slope of less cost acceleration.

The Robert Woods Johnson Foundation has released preliminary 2015 results on medical service pricing:

We have observed many times that growth in health service prices remains extremely low, and this month’s trend report suggests that this trend is continuing, reporting an annual increase in health care prices for 2015 of 1.1 percent, the lowest recorded since Altarum’s series began in 1990. Given the flatness of this series, the two drivers of the recent growth in health spending have been coverage expansion and spending on prescription drugs.

In 2015, the nominal GDP growth was 2.9%.  Inflation was roughly 1%.  Healthcare price inflation was within rounding errors of general inflation.  This is extremely important news.

However cost control is not only a matter of price. It is a matter of quantity.

Everyone expected quantity of services to go up significantly. The CBO had projected a spike in GDP devoted to healthcare spending in 2014 and 2015 because it was projecting the US uninsurance rate to be cut in half.  Below is a November 2013 chart from the  White House  that shows how the CBO anticipated a spike:

WH HC Spend Spike

The RWJF research shows that spike shown through the data:

This month’s results are quite consistent with this foreshadowing. The quarterly trend in overall health spending growth using the Altarum Health Spending Economic Indicators series shows a clear peak in Q1 2015 at 6.7 percent, with subsequent declines every quarter. Partial data for Q4 (October and November) show a spending growth rate of 5.2 percent. While overall spending growth in 2015 will clearly exceed that of 2014, a reduction appears to be underway.

Total spending is a function of the average price per service and the number of services being sold.  Since we expanded access to health insurance and healthcare with the biggest wave of new entrants to the system happening in 2014 and 2015, the number of services being used should have gone up.  They did.  Some of that incremental increase was due to “catch-up care“.  That wave seems to have crested.  The rest of the increment is the “natural” healthcare utilization rate of newly insured people who have had their “gonna kill me now” problems taken care of.

Charles Gaba has argued, the easy large scale additions to the ranks of the insured is complete.

6. The remaining uninsured STILL haven’t a clue about the deadlines and/or tax penalties:

The final factor is one which I’ve written about before, and which there seems to be no obvious solution to: In spite of a massive outreach/marketing/eduction effort by HHS, CMS, HC.gov, the state exchanges, the private insurance carriers, Enroll America, Families USA, Planned Parenthood, the United Way and dozens of other organizations,people STILL had no idea about the deadline and/or mandate tax:

This will change once the large population former Confederate states expand Medicaid at some point in the next decade but there are not big pools of easy conversions readily available.

What does this mean?

The cost curve is bending.  If prices can grow at roughly the rate of inflation and not even nominal GDP quite a few long term federal financing problems go from dire to manageable.








School lunches and Medicaid: a BFD

This is a Big Biden Deal:

Kids who have enough to eat and are not worried about having enough to eat have two significant advantages over kids who don’t have enough to eat and have to worry about that. The first is simple, they have more energy to spend on high intensity activities of play and learning (speaking as a dad of a first grader, those two things should be very close to the same a good chunk of the time). Secondly and slightly more subtly, kids who are not worried about their next meal are able to devote high complexity cognitive processes to other things. Kids (and adults) have a finite amount of brain horsepower available at any given time. Not worrying about food frees up capacity for other things. Kids who are worried about food are devoting a limited brain budget to that task and not to other things.

The free and reduced price school lunch program in most districts except for high poverty districts like the one my family lives in has a significant amount of paperwork and potential stigma attached. Some of that paperwork will deter people who qualify from signing up. Some proportion of those people who are deterred will have signed up for Medicaid or CHIP. Both of those programs have routine income verification processes. Both of those programs are far more valuable on a cash value basis than school lunches so the cost of not hurdling an administrative barrier is higher and more visible. Compliance is higher.

Allowing states to use pre-exisiting data to pre-qualify kids for free or reduced price school lunches will help a few more kids get a quality daily meal or two in their stomachs which should increase their well being in addition to improving school performance. It is also an example of the government working to actively improve peoples’ lives while streamlining the interaction.

This is a good thing now that it is optional. If we could only make it mandatory that states use Medicaid or SNAP eligiblity data to drive the full array of income qualified social services instead of silo-ing different categories of assistance so duplication and administrative burden increases wasted costs without providing qualified individuals the services and assistance that they need.








Seven Years Ago Today: Hope and Change

I don’t know about you, but for me it was an amazing day. Amazing. So many things I never thought I would see in my lifetime. I am so proud of this man and so proud that we worked our butts off to help him get elected.

Here is the C-Span full archive of video of the events of the day.

We cannot backtrack. We cannot.

Consider this an open thread. Cheers.