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Why It Doesn't Matter If People Aren't Signing Up for Obamacare Yet

| Tue Oct. 8, 2013 6:00 AM EDT

Republicans have been insisting for a week now that Obamacare is a failure because immediately following its official debut on October 1, few people actually signed up for subsidized insurance plans through its new health exchanges. "Error message after error message. Failed security standards and 60 hours on website hold for just this one Kansan. It is clear, Obamacare is failing — an embarrassment, particularly for the former Kansas governor who is now in charge of Obamacare," Rep. Tim Huelskamp (R-Kan.) complained on the House floor last week.

But it doesn't really matter whether many people enrolled in Obamacare last week. Healthcare.gov saw 8 million unique visitors in the first four days the exchanges were open. It isn't especially surprising that not all those people managed to get covered on Day 1. The coverage people are seeking isn't even available until January 1. Uninsured Americans have until December 15 to sign up for coverage that starts the first of the year, and another three months to sign up during the open enrollment period that ends March 31. (People can still sign up after March 31 if they have a change in status, such as losing employer-based coverage.) If people weren't able to sign up October 1 or even October 5, that's not the end of the world. It's just the beginning.

Experience shows that getting lots of uninsured people into private health plans and new Medicaid plans is maddeningly difficult and time-consuming. Massachusetts has already done this, after all. In 2006, Gov. Mitt Romney signed into law a health care reform bill that is essentially the model for the Affordable Care Act. Like the ACA, Romneycare expanded the state's Medicaid program and then opened the Massachusetts Health Connector, the prototype of Healthcare.gov, to provide a marketplace where state residents could purchase subsidized individual health insurance plans.

What happened in Massachusetts is pretty much exactly what's happening right now with Obamacare. After the law went into effect in Massachusetts, state offices were totally overwhelmed by the number of people clamoring to sign up for insurance, or what the state's Medicaid director dubbed the "stress of success." Lost paperwork, computer glitches, confusion over who was eligible for what, and not enough staff to handle the workload meant that in those early days, consumers could wait several months after submitting an application to finally get coverage. So many people were trying to enroll in the expanded Medicaid program that the Medicaid agency ended up with a months-long backlog of applications. In the first two months, only 18,000 of more than 200,000 potentially eligible people had successfully signed up through the connector, according to Jonathan Gruber, an MIT professor who helped design the Massachusetts system and served on the Connector board. And all of that happened in a state with only 300,000 or so eligible applicants and without a well-funded opposition trying to derail the law at every turn. 

But guess what? Eventually the kinks got worked out and people got covered. Enrollment opened in October 2006, and by the deadline for getting mandatory coverage, July 1, 2007, the Boston Globe reported, 20,000 more people had signed up for insurance on the exchange than the state had expected—12,000 of them in just the two weeks before the deadline. Total enrollment went from 18,000 in December 2006 to 158,000 a year later, says Gruber. Today, Massachusetts has the lowest rate of uninsured residents in the entire country—less than 4 percent—and polls show that people are generally happy with how everything worked out. The conservative Massachusetts Taxpayers Foundation has called the state's health care reform law “a well thought-out piece of legislation.”

The federal exchange is fielding vastly more work than the Massachusetts Health Connector, and if it's having trouble with the workload, that's largely thanks to Republican opponents. The drafters of the ACA never envisioned the federal government running health care marketplaces for most of the country. The ACA was specifically designed to respect the state's rights that Republicans claim to care so much about. It empowered states, which already regulate the sale of insurance, to run the exchanges. Healthcare.gov was supposed to be a backstop for states either too small to run their own or that dropped the ball on setting up their own exchanges. Instead, Republican governors across the country, and mostly in the South, abdicated the job completely. So instead of running a marketplace for a couple of states as planned, Healthcare.gov is having to do the work of 70 percent of them, including big states like Florida, Texas and Virginia (and also, ahem, Kansas). Of course the site was going to have some problems!

The first real measure of how well the system works is still a few months away. Given the human propensity to procrastinate, the surge of actual enrollments will probably come, as it did in Massachusetts, in the week or two before the first coverage deadline on December 15. That's when people will realize that coverage starts within days—not months or years—and start making decisions in earnest. Bronze plan or silver? Blue Cross or Aetna?

If only a handful of people have successfully enrolled by then, it won't be just conservatives who are freaking out.

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Is October 17 Still the Drop Dead Date for the Debt Ceiling?

| Tue Oct. 8, 2013 12:28 AM EDT

I'd still like to know if Treasury thinks October 17 is the drop-dead day for hitting the debt ceiling. I've looked through the various numbers about federal income and outgo, and I accept that the government shutdown probably doesn't affect spending all that much. But it does affect it some, and I'd like to know how much.

Here's why. If October 17 rolls around and Jack Lew suddenly announces that, thanks to the shutdown, we have some extra time before the sky falls, it's going to feed the shockingly common Republican belief that all the debt ceiling chatter is little more than liberal scaremongering. For the same reason, I'd like Treasury to tell us definitively if they can prioritize payments or not. Because if it turns out they can, and the worst effects of the debt ceiling can therefore be deferred, Republicans will take it as even further evidence of scaremongering.

I know Treasury is in a tough position. But it could be disastrous if they've been less than 100 percent forthright and pundits everywhere start claiming that the whole thing has been a cynical game and there was never any serious danger after all. It wouldn't be true, but it would nonetheless make resolution of the debt ceiling crisis even harder than it seems now.

New Study Says Conservatives React More Strongly to Insults Than Liberals

| Mon Oct. 7, 2013 9:16 PM EDT

Via Henry Farrell, here's something that won't surprise you at all. Lafayette College professor Elizabeth Suhay ran an experiment recently that tested the effect of incendiary blog comments. As you can see in the chart below, when the test included obnoxious liberal comments, it didn't have much effect on liberals compared to a control group. But conservatives reacted pretty strongly. The comments pissed them off and their views became even more conservative than before:

Like I said, this is no surprise. You'd expect conservatives to react more strongly than liberals to liberal insults.

But here's the surprise: Another version of the test included obnoxious conservative comments. And the results were the same. Liberals pretty much shrugged off the insults, but conservatives reacted strongly compared to a control group. When they read nasty comments from their fellow conservatives, it fired them up to be even more conservative than before:

Now, there are a few reasons to take this with a grain of salt. First, it's only one study. There may be problems with methodology or question wording or a dozen other things. Second, this is pretty much what we liberals would like to believe, isn't it? That should give us pause before we get too self-righteous over this. Third, the study was done using volunteers recruited via Mechanical Turk, and I've had some pretty uncomplimentary things to say about MT before.

Still, it's intriguing and certainly deserves some follow-up. I presume this result is related in some way to the fact that conservatives tend to have higher in-group loyalty than liberals, but that's just an armchair guess. Maybe further research could dig into that.

From a political point of view, I guess the big question this study raises is: What fires up liberals? We have a pretty good idea of what fires up conservatives, but what gets us lefties going?

Easy to Get Plan B? Not Always

| Mon Oct. 7, 2013 7:40 PM EDT

Last June, after a protracted political fight and complicated legal battle, the US Food and Drug Administration approved the use of Plan B One-Step emergency contraception for all women of childbearing age without a prescription. The move marked a major victory for reproductive rights activists, and for women and men everywhere who are now supposed to be able to pick up the morning-after pill off of pharmacy and grocery store shelves without being required to show ID or proof of age.

But five months after the FDA's approval, consumers are still having problems accessing the 72-hour pill. Some of the problems stem from confusion about the law, or from a bureaucracy slow to update the regulations. In other cases, women are deterred by misinformation about the medication; it's known in pro-life circles, for instance, as an "abortion pill."

These barriers prompted a group of media outlets to launch "Where is your Plan B?", a reporting and crowd-sourcing collaboration to determine how easily women can access Plan B One-Step in their communities. (Disclosure: Some of the outlets belong to The Media Consortium, which The Foundation for National Progress, Mother Jones' parent organization, co-founded.)

How Bad Is the Income Gap in Your City? The Answer in GIFs

| Mon Oct. 7, 2013 4:33 PM EDT

Artist and researcher Nickolay Lamm recently created these eye-popping 3-D images of New York City's towering levels of incoming inequality.

Lamm has now expanded his project to include other major US cities. As you'll see in the GIFs below, San Francisco, Boston, Chicago, Los Angeles, and Miami are now part of the 3-D inequality club. Using 2012 data from the mapping site ArcGIS, Lamm superimposed green blocks representing the median net worth of census block groups over photos of the cityscape. The effect clearly visualizes the drastic levels of income inequality found across the country.

San Francisco
San Francisco
San Francisco
San Francisco
Boston
Boston
Boston
Boston
Chicago
Chicago
Chicago
Chicago
Los Angeles
Los Angeles
Miami
Miami
Miami
Miami

View Nickolay's original post of these images here.

Why Washington Is Stuck in an Endless Loop of Dysfunction and Squabbling

| Mon Oct. 7, 2013 2:51 PM EDT

Today Ezra Klein lists "The 13 reasons Washington is failing," and to be honest, I was all ready not to like this post. I mean, seriously? Thirteen reasons? Spare me.

But it's pretty good! Sure, numbers 5, 10, and 11 are kinda the same, but that's OK. It's an idea that deserves some repetition. And many of the others don't always get the attention they deserve even though they're surprisingly important. The most important one of all, I think, is way at the bottom of the list at #13. Generally speaking, I'm not part of the crowd that thinks we're doomed to eternal gridlock and dysfunction, but there's not much question that the transformation of American parties into ideological European-style parties is very, very, underappreciated. Regardless of how our current crisis works itself out, we're on a massive collision course between de facto parliamentary rule, with party discipline as its fundamental feature, and a presidential system that never developed the parliamentary norms that make this work.

Maybe we'll work things out. But governing norms are critical when the actual governing rules are incoherent, as ours have become, and the Republican Party has been gleefully tearing down governing norms ever since Newt Gingrich took over. I'm not sure how this is supposed to end.

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Maybe Obama's Team Needs to Be a Little More Alarming on the Debt Ceiling

| Mon Oct. 7, 2013 1:26 PM EDT

Bob Somerby writes today about Sen. Rand Paul's appearance on Meet the Press this weekend, but throws in an aside about Treasury Secretary Jack Lew's appearance:

[Paul] followed Jack Lew, who pretty much convinced the nation that we have little to fear from a failure to raise the debt limit. We know, we know! Lew was trying to say the opposite. But what a horrible, narcotized spokesman!

It's true that Lew took a pretty low-key approach, despite host Savannah Guthrie's best efforts. "Are you talking catastrophe?" she asked. Lew wouldn't bite, so then she gave him another chance. "It would be calamitous for the economy?" Still no bite! "It would be very bad," was the worst Lew could summon up.

That's pretty soporific, all right. The problem, I assume, is that Lew is in an impossible situation. Breaching the debt ceiling would be pretty calamitous, but Treasury secretaries have an obligation not to panic markets with loose talk. Backbench congressmen, by contrast, can say anything they think might get them a few minutes on the evening news.

It's an asymmetrical war, and it's not clear what the answer is. Administration officials have a fine line to walk, trying to make sure they have well and truly warned everyone about how disastrous a debt ceiling breach would be, but at the same time not sending markets into a tailspin unnecessarily. I'm not sure what the answer is, but I think Bob is right: Lew pushed the balance a little too far into yawn inducing territory yesterday. He needs to be clearer about what exactly would happen once we finally get to the day when we can't pay our bills.

Ted Yoho: We Must Destroy the World In Order to Save It

| Mon Oct. 7, 2013 12:34 PM EDT

Government policy may or may not have been a prime cause of the 2008 financial crisis, but Dan Drezner says it sure is a prime cause of the lousy recovery since then:

A standard lament about the 2008 financial crisis is that it happened because of "market fundamentalism."....But between the Eurozone crisis and U.S. policy deadlocks, it's striking how much the gyrations of the past few years are because of governance failures. And it's depressing to consider how much better the global economy would be doing if politicians in the advanced industrialized economies were a bit better at their jobs.

Yep. And speaking of governance failures, here is Rep. Ted Yoho over the weekend:

"I think we need to have that moment where we realize [we’re] going broke. If the debt ceiling isn’t raised, that will sure as heck be a moment. I think, personally, it would bring stability to the world markets," since they would be assured the United States had moved decisively to curb its debt.

Yes indeedy. Breaching the debt ceiling will bring stability to world markets. I wonder what other ideas Yoho has for bringing stability to world markets? I'd love to hear them.

I think Yoho deserves to be immortalized for this. As we all know, the increasingly annoying acronym YOLO means You Only Live Once. So what does YOHO stand for? You Only Hijack Once?

How Population Genetics May Help Explain Economic Growth

| Mon Oct. 7, 2013 11:18 AM EDT

Alex Tabarrok links to a short post today by a couple of researchers who study the transmission of ideas throughout history. Their conclusion is that the speed of diffusion depends on a country's "genetic distance" from the source of the idea, and when I first read this I thought they were using genetic distance as a metaphor of some kind. That is, they were measuring the distance between various cultures, and the math happened to be similar to the math for measuring the genetic distance between human population groups, so that's what they called it.

But no. The two researchers, Enrico Spolaore and Romain Wacziarg, are literally talking about population genetics:

Measures of average differences between vectors of allele frequencies (different genes) across any two populations provide a measure of genetic distance....The goal of this approach is not to study any genetic characteristics that may confer any advantage in development....On the contrary, they are neutral: their spread results from random factors and not from natural selection. For instance, neutral genes include those coding for different blood types....Instead, genetic distance is like a molecular clock — it measures average separation times between populations. Therefore, genetic distance can be used as a summary statistic for divergence in all the traits that are transmitted with variation from one generation to the next over the long run, including divergence in cultural traits.

Their hypothesis is that populations that are genetically more distant are also culturally more distant and are therefore more resistant to trading and adopting each others' cultural traits. In the case of the Industrial Revolution, the epicenter was in Great Britain, so the adoption of new technology was strongly influenced by the genetic distance of different populations from Britain. Sure enough, they claim that was the case. The chart on the right shows the effect of genetic distance from Britain on the adoption of machine technology. It starts out fairly modestly, rises to a high level by 1913, and then declines as technology finally diffuses everywhere.

In a sense, this comes as no surprise. Genetic distance is pretty obviously correlated with both physical distance and cultural distance, so you'd expect that it might also correlate with the spread of ideas as well. Path dependence and deliberate policy (for example, colonial rules that deliberately inhibited the spread of technology) can then account for most of the rest. Spolaore and Wacziarg's conclusion:

In sum, we find considerable evidence that barriers introduced by historical separation between populations are central to account for the world distribution of income....These results have substantial policy implications. A common concern when studying the persistent effect of long-term history is that not much can be done today. But if a major effect of long-term historical divergence is due to barriers, there is much room and scope for policy action. Populations that are historically farther from the frontier can benefit from policies that specifically aim at reducing barriers to exchange and communication.

Needless to say, "reducing barriers" is a two-edged sword. But it's an interesting proposition nonetheless.

Democratic Super-PAC Targets GOP "Crybabies" With Hilarious Ad

| Mon Oct. 7, 2013 10:57 AM EDT

Here's a political ad that gets right to the point.

House Majority PAC, the super-PAC angling to win back the House for the Democrats next year, is on the airwaves with a new TV ad depicting a crying baby and likening a crew of House Republican lawmakers to petulant children. The ad targets House Speaker John Boehner (R-Ohio) and a crew of tea party lawmakers—including Reps. David Joyce (R-Ohio), Gary Miller (R-Calif.), Mike Coffman (R-Colo.), Rodney Davis (R-Ill.), and Mike Fitzpatrick (R-Pa.)—saying these GOPers are, well, big crybabies throwing a temper tantrum over their failed efforts to derail Obamacare.

"Speaker John Boehner didn't get his way on shutting down health-care reform," the ad's narrator says. "So he shut down the government and hurt the economy." The ad features the Twitter hashtag #GOPTemperTantrum.

The partial shutdown of the federal government now enters its second week, with no resolution in sight. On ABC's This Week, Boehner said he would not move to reopen the government until President Obama agrees to negotiate over Obamacare, the centerpiece of which went into effect last Tuesday. Asked whether the nation was set to default on its obligations in mid-October when it hits the government's borrowing limit, Boehner replied, "That's the path we're on." Obama, of course, refuses to enter talks about weakening or defunding his health insurance overhaul.

Don't be surprised, then, to see more crying babies on your TV set in the days ahead.