American health-care act

[jkudler]

ugh, the last thing I need is to get into another discussion like this with the kud, but:

right.

yes, the plan costs a lot of money. but it's also PAID FOR in the bill, via some savings and various new taxes. you can argue that those making over $250k/yr should be able to keep that extra 3% or whatever it is, but you can't argue that the bill is a drain, as it actually *shrinks* the deficit.

you absolutely can't say this like it's a fact, no matter who has studied it or signed off on it. no one has any real idea and won't for years, it's too complex.

sure. i can add a bunch of modifiers - i mean, i can't say "the sun will rise tomorrow" for a fact either, but all the projections, including from the CBO, are that it's going to reduce the deficit. maybe i should have just said, "if you want another put of view from what richard said, a large non-partisan federal agency that conducted numerous studies and analyses says different from what richard kamerman says" and we can move on.

-j.

[jon abbey]

just to be clear, I'm for this bill, I just don't understand why intelligent people would be so trusting about a macroeconomic forecast that involves so many unknown variables, especially when so many others have been so wrong in recent years. yes, the CBO said that, but why would anyone believe that they know what they're talking about?

FWIW, here's a former CBO head saying the exact opposite, I'd say logic is more on his side than on that of the current CBO:

http://www.nytimes.com/2010/03/21/opini ... eakin.html

the last sentence below sums up so much of economic forecasts IMO:

"The answer, unfortunately, is that the budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed. So fantasy in, fantasy out."

the job reports are like this too, making up hundreds of thousands of imaginary jobs due to 'seasonal conditions', then later quietly erasing them when (surprise, surprise) it turns out they never existed.

[faster]

I think it's likely the HCR will add to the deficit, but the deficit is spinning out of control already, and I'm glad at least some of the reckless spending is for something that does not involve killing hundreds of thousands of people. I also think the cat's out of the bag, now, and that HC is here for good, more or less, and--I say this not without knowledge that it's hopeful and unfounded--may become closer to equitable and good over time. It's hard for me to imagine Americans continuing to oppose something that may well get their existing health conditions covered by insurance for very long. But I've been wrong before and don't have a camel in this race. South Korea, by the way, has a terrific and sensible national health care system. Jeong Eun went to the doctor today and then the pharmacy, and paid a grand total of about US$8.

[jon abbey]

I think it's likely the HCR will add to the deficit, but the deficit is spinning out of control already, and I'm glad at least some of the reckless spending is for something that does not involve killing hundreds of thousands of people.

now this I can agree with.

[faster]

By the way, I just learned that the US is #43 in the world in life expectancy. Analysts are almost in complete consensus that the reason for this is health care. So there may be a drawback to the HCR: more Americans.

[jon abbey]

just two years ago, in 2008, the CBO was saying that we would actually be in surplus from 2009-2018.

"Comparing the CBO's outlook in 2008 to the current forecast, CNBC found that what was once a projected $247 billion surplus for the years 2009 through 2018, is now an estimated $7.4 trillion deficit. "

http://www.cnbc.com/id/36054221

if they're that off trying to predict the economy, why would anyone take them seriously when crunching numbers on something with as many unknowns as the health care bill?

[will]

Agreed that it might wind up being expensive, or that costs are generally hard to predict. How many lives is it going to save / improve? I think that any argument about cost should be tempered by the probable benefits of the proposed changes.

[Vincent Kargatis]

I think that any argument about cost should be tempered by the probable benefits of the proposed changes.

Of course that's true - that's the idea behind the exotic :) notion of "cost-benefit analysis". One big problem with the current bill and surrounding politics is more the opposite - that the benefits are not tempered by consideration of (reasonable) costs. Following on Jon's point about the CBO, Greg Mankiw notes reasons to be skeptical about their analysis here and here, regarding the aforementioned fact that they're required to use assumptions that aren't particularly justified.

A fundamental problem with the process as I see it is that afaik the bill contains no substantial efforts to rein in actual health care costs, despite the basic incentivizing complaint that "health care is too expensive". If you don't work on reducing real costs while trying to expand access, you're likely screwed in achieving your long term goal.

[will]

I think that any argument about cost should be tempered by the probable benefits of the proposed changes.

Of course that's true - that's the idea behind the exotic notion of "cost-benefit analysis". One big problem with the current bill and surrounding politics is more the opposite - that the benefits are not tempered by consideration of (reasonable) costs. Following on Jon's point about the CBO, Greg Mankiw notes reasons to be skeptical about their analysis here and here, regarding the aforementioned fact that they're required to use assumptions that aren't particularly justified.

A fundamental problem with the process as I see it is that afaik the bill contains no substantial efforts to rein in actual health care costs, despite the basic incentivizing complaint that "health care is too expensive". If you don't work on reducing real costs while trying to expand access, you're likely screwed in achieving your long term goal.

Yeah, I was trying to be all clever by extending the phrase into a sentence. Regarding the included blog posts, I think taht this one http://gregmankiw.blogspot.com/2010/03/ ... ahead.html does a good job of conditioning the other posts. If we're forecasting, we could consider the impact of improved health on the economy as a whole, or the impact of altered consumer expectations about kinds and urgences of disposable income, or whatever we like, everything gets entertainingly nonlinear, particularly when the cbo admits that they are sort of confabulating.

[Nim Chimpsky]

that's the idea behind the exotic notion of "cost-benefit analysis".

I've heard some people in the UK arguing for a healthcare model similar to Singapore for essentially 'cost-benefit' reasons. Singapore only spends about 3% of GDP on health but has the joint lowest infant mortality rate in the world (picking one of many positive measures on the standard of public health). Before reforms I think I'm right in saying that the US spends something like 16% so it already looks like a pretty expensive system.

[jkudler]

greg mankiw's sorta bag is being a "reasonable" or at least "intelligent" conservative economist who can at least make arguments for his points (quite the rarity). that said, he was a major proponent of bush's tax cuts for the wealthy, perhaps the most daringly fiscally irresponsible element of one of the most fiscally irresponsible administrations in history. like others said, insuring more people is probably a good use of government spending. i wonder where all these deficit hawks were during the two wars, the huge bush tax cuts, and medicare part d.

while it's true that the CBO score has to be necessarily based on specific assumptions (rosy GDP estimates were because they can't, for reasons i hope should be obvious, predict 'black swan' type events like the collapse of lehman and subsequent implosion), and i'm sure there was some accounting trickery, but that can also work the other way, where there is unexpected savings or revenue. tax receipts could really shoot up suddenly with a recovery, for example.

i think the post will shared from mankiw makes pretty clear his major opposition to the bill is philosophical, and he and i are on opposite philosophical sides: he thinks extending health care availability is not worth raising taxes. pretty much full stop. i think a civil society provides universal health care and tolerates a slightly higher tax burden. like. . . every single developed country in the world. i mean, do you guys wonder how they all do it? talk to any musician in england, france, germany, austria, switzerland, canada, etc. it's also probably a major reason there isn't more good music coming from this country: it's very very hard to be an artist with the lack of social safety net.

mankiw mentions as an aside that his colleague, who specifically works on health care matters, thinks the bill has major cost-saving components. and as will said, there can be all kinds of unpredictable effects.

A fundamental problem with the process as I see it is that afaik the bill contains no substantial efforts to rein in actual health care costs, despite the basic incentivizing complaint that "health care is too expensive". If you don't work on reducing real costs while trying to expand access, you're likely screwed in achieving your long term goal.

i agree that this is the single biggest problem in the bill. it does far too little (though it has a bunch of 'trial programs' that could potentially lead to something) to rein in costs, and it does almost nothing to change things for employer-based insurance. this is the shittiest part of the politics. both sides are very much to blame, though the talk of death panels and government takeovers and all the grandstanding about medicare really did not help things. but like with taxes, americans hate sacrifice, and this is another example of that. i am really hoping something can be done, but i am not super-optimistic right now. people freak out at the word "rationing" now and are not capable of understanding the fact that we have massive rationing already, only based on ability to pay as opposed to need.

-jesse

ps to nim - yes, the US has one of the highest per capita spending rates on healthcare in the world and some of the highest infant mortality and lowest life expectancy among similar countries (wealthy developed ones)

[mudd]

health insurance reform isn't really health care reform. both are necessary, but this was really just the former with small head-nods towards the latter.

m

[RFKorp]

greg mankiw's sorta bag is being a "reasonable" or at least "intelligent" conservative economist who can at least make arguments for his points (quite the rarity). that said, he was a major proponent of bush's tax cuts for the wealthy, perhaps the most daringly fiscally irresponsible element of one of the most fiscally irresponsible administrations in history.

Just for the record, the Bush-era tax cuts were not only for the wealthy. He brought capital gains tax down to ZERO for a really significant low income bracket of our country.

talk to any musician in england, france, germany, austria, switzerland, canada, etc. it's also probably a major reason there isn't more good music coming from this country: it's very very hard to be an artist with the lack of social safety net.

I completely disagree with this. While it's clear there is MORE music coming from those countries, there is absolutely no reason to say there is more GOOD music. In fact, I would say my observation is the opposite. The struggle to get your work out there even when you can't live on it, creates a more difficult wall for the crap to scale over. An that's a good thing.

[faster]

The struggle to get your work out there even when you can't live on it, creates a more difficult wall for the crap to scale over. An that's a good thing.

Whether this is true or not is a matter of taste, and it makes me wonder if maybe you also support further strictures and obstacles for people who want to make music.

But either way, are you implying that good records are more important than, say, life expectancy or death by easily curable ailment?

[RFKorp]

The struggle to get your work out there even when you can't live on it, creates a more difficult wall for the crap to scale over. An that's a good thing.

Whether this is true or not is a matter of taste, and it makes me wonder if maybe you also support further strictures and obstacles for people who want to make music.

But either way, are you implying that good records are more important than, say, life expectancy or death by easily curable ailment?

I don't at all support any kind of restrictions on or obstacles in the way of people playing music (or pursuing any creative practice for that matter). I'm not even sure where that idea comes into play.

But I think too much of a "social safety net" makes people complacent. And, in general, I don't think it's outlandish to suggest that an increasingly complacent society will have an increasingly stagnant artistic culture.

I'm really not talking about commodities, either. A good record is worth nothing compared to a healthy life. And a creative and fulfilling artistic career need not even be documented on record to have a social impact.

[faster]

But I think too much of a "social safety net" makes people complacent. And, in general, I don't think it's outlandish to suggest that an increasingly complacent society will have an increasingly stagnant artistic culture.

Really? How many of the musicians you know and love in the US or elsewhere has lived without a "social safety net"? I know I've always had one, and I suspect you have too. I mean, my parents were teachers, bug I grew up on the mean streets of Pebble Beach, CA, with nothing but support on all sides.

[RFKorp]

But I think too much of a "social safety net" makes people complacent. And, in general, I don't think it's outlandish to suggest that an increasingly complacent society will have an increasingly stagnant artistic culture.

Really? How many of the musicians you know and love in the US or elsewhere has lived without a "social safety net"? I know I've always had one, and I suspect you have too. I mean, my parents were teachers, bug I grew up on the mean streets of Pebble Beach, CA, with nothing but support on all sides.

OK. I obviously hit submit too fast.

A "social safety net" of family both biological and otherwise. yeah, key importance in life.

Government programs as a surrogate safety net for those who absolutely need it? Fine.
For those who already have a supportive network behind them? Not so sure.

My initial statements were also somewhat a kneejerk reaction to what I considered an implied point about arts funding in Jesse's post.

[jkudler]

greg mankiw's sorta bag is being a "reasonable" or at least "intelligent" conservative economist who can at least make arguments for his points (quite the rarity). that said, he was a major proponent of bush's tax cuts for the wealthy, perhaps the most daringly fiscally irresponsible element of one of the most fiscally irresponsible administrations in history.

Just for the record, the Bush-era tax cuts were not only for the wealthy. He brought capital gains tax down to ZERO for a really significant low income bracket of our country.

this brings to mind a favorite quote:

The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread.

-Anatole France

while what you said is technically true, i can't imagine it amounted to very much tax savings, as the lowest tax brackets own very little investment capital. and regardless, the bulk of these cuts went to the rich.

talk to any musician in england, france, germany, austria, switzerland, canada, etc. it's also probably a major reason there isn't more good music coming from this country: it's very very hard to be an artist with the lack of social safety net.

I completely disagree with this. While it's clear there is MORE music coming from those countries, there is absolutely no reason to say there is more GOOD music. In fact, I would say my observation is the opposite. The struggle to get your work out there even when you can't live on it, creates a more difficult wall for the crap to scale over. An that's a good thing.

joe pretty much beat me to the logical reply to this. i was not making a point about arts funding. i was making a point about being able to pursue art without worrying that a freak bike accident will bankrupt one for life.

While it's clear there is MORE music coming from those countries, there is absolutely no reason to say there is more GOOD music.

well, your best of 2009 list is disproportionally non-american (link)

although joe is of course correct in saying that maybe people's welfare should be more important than what we here consider good music. that said, i am excited to see what EAI records come out of liberia this year.

-jesse

[jkudler]

just to be clear, I'm for this bill, I just don't understand why intelligent people would be so trusting about a macroeconomic forecast that involves so many unknown variables, especially when so many others have been so wrong in recent years. yes, the CBO said that, but why would anyone believe that they know what they're talking about?

FWIW, here's a former CBO head saying the exact opposite, I'd say logic is more on his side than on that of the current CBO:

http://www.nytimes.com/2010/03/21/opini ... eakin.html

the last sentence below sums up so much of economic forecasts IMO:

"The answer, unfortunately, is that the budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed. So fantasy in, fantasy out."

the job reports are like this too, making up hundreds of thousands of imaginary jobs due to 'seasonal conditions', then later quietly erasing them when (surprise, surprise) it turns out they never existed.

i know you don't like krugman, jon (though of course i have no idea why), but a friend pointed out to me earlier his dismantling of this op-ed:
http://krugman.blogs.nytimes.com/2010/0 ... nder-vile/

as far as i can see, his reasoning is pretty airtight.

-j.

(ps, he's sanguine on deficits too: http://krugman.blogs.nytimes.com/2010/0 ... rief-note/)

[RFKorp]

well, your best of 2009 list is disproportionally non-american (link)

Touché I guess. Though I'm not totally convinced it's that out of proportion. Fewer American releases on the list but wouldn't you observe there are also FAR fewer American releases in general in the relevant area of music? Lots of great players, lots of great concerts, not a lot of commercial documentation.