It’s Tuesday. Mitch McConnell has promised to vote on repealing Obamacare today, so that means senators will finally be told exactly what they’re voting on. Right? Politico has the deets:
At stake is not just the seven-year-old campaign pledge to repeal Obamacare, but also demonstrating that Republicans — when given full control of Washington — can govern….The vote count was unclear as of Tuesday morning. About a half-dozen senators were publicly undecided about whether to allow debate to start on rolling back the Affordable Care Act.
….It is still unclear what policy the Senate is going to vote on. To get their members on board, Republican leaders are being as vague as possible about what the final bill to replace Obamacare would include, after two recent drafts met fatal opposition.
Credit where it’s due: this is a very creative strategy. Just keep everyone in the dark and don’t tell them what they’re voting for. This kind of fuzziness worked great on the campaign trail for the past seven years, so why not try it on an actual floor vote? And who knows? Maybe there’s a last-minute provision in the bill that names Mitch McConnell king of the world. Who would ever know?
I finished reading Elisabeth Rosenthal’s An American Sickness a few days ago, so the depradations of the American health care system are even fresher on my mind than usual right now. Unsurprisingly, one of the things she talks about is the surge in hospitals surreptitiously employing doctors who are out-of-network and therefore not covered by a patient’s insurance. The result is gigantic bills for people who thought—quite reasonably—that if they went to an in-network hospital they had nothing to worry about.
It turns out this scam is especially common in emergency rooms, precisely the place where patients are least likely to be thinking clearly. Today, the New York Times writes about what happens when ER services are outsourced to a company called EmCare. A chart is worth a thousand words, so here’s 8,000 words on the subject:
When EmCare takes over, out-of-network billing jumps almost instantly from about zero to about 100 percent. But is EmCare really the culprit? Here’s an excerpt from the Times piece:
Early last year, executives at a small hospital an hour north of Spokane, Wash., started using a company called EmCare to staff and run their emergency room….Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks and were sending high bills directly to the patients.
….“Fiona Scott Morton, a professor at the Yale School of Management and a co-author of the paper, described the strategy as a “kind of ambushing of patients.” A patient who goes to the emergency room can look for a hospital that takes her insurance, but she almost never gets to choose the doctor who treats her.
….When emergency room doctors work for a company that has not made a deal with an insurer, they are free to bill whatever they want, insurers say. “The more they bill, the more they get paid,” said Shara McClure, an executive with Blue Cross of Texas.
Hospitals know perfectly well that patients expect doctors at in-network hospitals to also be in-network. That’s why hospitals negotiate with insurers in the first place: to get a place in the insurer’s network so they can attract the insurer’s customers.
Likewise, if they contract with a third-party firm to run a part of their hospital, they know perfectly well what will happen if the third-party hasn’t negotiated with the same set of insurers: their patients will get outrageous out-of-network bills.
Unlike patients, hospitals are sophisticated actors. They know enough to ask whether or not EmCare’s doctors belong to their networks. Obviously they did ask, and just as obviously the answer was no. But they signed up with EmCare anyway.
So whose fault is it that ERs are increasingly turned over to outfits like EmCare and that EmCare charges sky-high rates? It’s the fault of the hospitals who knowingly do this because it helps them run more profitably.
EmCare is hardly blameless here. Scams like this depend on everyone buying into a clever new idea. But if hospitals refused to deal with EmCare unless EmCare signed up for the same networks the hospital advertises itself belonging to, none of this would happen.
This is a great blue heron down at Dana Point. It flew right by my ear and then settled down on the rocks long enough for me to get surprisingly close. I guess they get used to human company down there.
Speaking of cherry-picked statistics, Brad DeLong is unhappy with John Cogan, Glenn Hubbard, John Taylor, and Kevin Warsh, who insist that Donald Trump might very well produce sustained economic growth of 3 percent. They back up their view with this chart of labor productivity:
Aside from looking like something a first-grader would put together, real economists don’t just draw miscellaneous arrows through data. DeLong shows how it’s done correctly, drawing a nonparametric smoothed lowess trend through a scatterplot. However, he admits that us amateurs could show the same thing using a standard-issue curve fitted by Excel. Here it is:
Hmmm. When it’s plotted with no particular bias to produce a specific result, it looks like productivity has been on a steady downward trend for the past 65 years, with a brief and modest uptick during the 90s.
Is it possible that tax cuts for the rich will produce a sudden, gigantic surge in productivity and therefore a sudden, gigantic surge in economic growth? Sure. Tax cuts for the rich have never produced this before, but anything is possible. Should you bet on it based on a crude chart drawn by folks who have an axe to grind? Well, it’s your money.
Today’s news: Lou Dobbs is great; Hillary Clinton is a criminal; Jeff Sessions is “beleaguered“; Adam Schiff is sleazy; Republicans are cowards; and anyone who suggests that Russia affected the election is insulting the white working class.
This is, of course, ridiculous. I cherry-picked these statistics; plotted them in a way that made their decline look enormous; and provided no context about what any of them looked like in the year before Trump took office. It’s an easy game to play, and it’s all meaningless.
So why bother? Just to make a point. Right now the economy is doing about as well as it’s been doing for the past few years. Nothing great, nothing terrible. You should pay no more attention to anyone who says the economy is booming under Trump than you should to anyone who says it’s collapsing. Right now, it’s just puttering along.
How far has the Democratic Party shifted in its support for truly universal health care? Jeff Stein reports:
Sen. Bernie Sanders (I-VT) is about to put Democrats’ newfound embrace of single-payer health care to the test….Despite the rise of “Medicare-for-all” as a political slogan in the party, Democrats don’t have a clear plan to translate that aspiration into policy, and their efforts to implement single-payer at the state level have been rebuffed — including in blue states like Vermont and California.
….Sanders will soon change that. The Vermont senator is expected to release his own revised Medicare-for-all bill, the path to single-payer health care. When he does so, Senate Democrats will have to make a choice they’ve thus far avoided: Are they for Medicare-for-all in practice, or just in theory?
Is this a good idea? On the one hand, Republicans never bothered with this during seven years of their “repeal and replace” campaign against Obamacare, and it worked great. Until they actually took power, that is.
On the other hand—well, I’m not sure I see the other hand. An actual bill gives Republicans a concrete target to rail against. It would include a bunch of new taxes. If its sums don’t add up, liberal analysts will say so because, for better or worse, that’s how liberal analysts roll. Its tradeoffs will all be front and center. It will make divisions within the Democratic Party sharper and more visible. From a purely political view, there’s not a lot of upside here to introducing actual legislative text.
If this bill came from anyone else, I’d assume there might be some give and take before it was made public. With Sanders, who knows? Stay tuned.
That’s bad. But it turns out there’s a vaccine for Lyme disease. Or I guess I should say, there used to be a vaccine for Lyme disease. In 1998 the FDA approved a a drug called Lymerix, and it was pretty effective until the chronic Lyme crowd and the anti-vaxxers started ranting:
Influenced by now-discredited research purporting to show a link between the MMR vaccine and autism, activists raised the question of whether the Lyme disease vaccine could cause arthritis. Media coverage and the anti-Lyme-vaccination groups gave a voice to those who believed their pain was due to the vaccine, and public support for the vaccine declined.
“The chronic arthritis was not associated with Lyme,” says Stanley Plotkin, an adviser to pharmaceutical company Sanofi Pasteur. “When you’re dealing with adults, all kinds of things happen to them. They get arthritis, they get strokes, heart attacks. So unless you have a control group, you’re in la-la land.”
But there was a control group – the rest of the US population. And when the FDA reviewed the vaccine’s adverse event reports in a retrospective study, they found only 905 reports for 1.4 million doses. Still, the damage was done, and the vaccine was benched.
All of you who have had Lyme disease should know this. You could have avoided it if not for the ravings of the anti-vax nitwits and the gullibility of the mainstream TV talkers who give them a platform. It’s long past time to put an end to this idiocy.
But I won’t leave you without some good news. First, although you can’t vaccinate yourself, you can vaccinate your dog. So there’s that. Second, a French company has developed an even better Lyme vaccination, and it should be ready in 2023. That’s a mere six years. Just be patient, OK?
It often slips people’s minds that the point of insurance is fundamentally financial. Auto insurance doesn’t prevent accidents, but it keeps you from going bankrupt over one. Ditto for homeowner’s insurance, life insurance, etc.
Health coverage is a little different because, in addition to being traditional insurance, it also pays for lots of routine medical care. Nevertheless, it’s still insurance. You can get medical care without it,¹ but it will cost you a fortune. So when you take a look at, say, Medicaid expansion, it’s at least as important to look at financial outcomes as it is to look at health outcomes.
Via Paul G-P on Twitter, here’s a CFPB study of how Medicaid expansion under Obamacare affected the finances of the poor. The authors take advantage of the fact that some states accepted the Medicaid expansion and some didn’t. They also have access to extremely detailed tradeline data in credit records. Here’s their basic result:
In states that didn’t expand Medicaid, nothing much happened. In states that did expand Medicaid, medical debt fell nearly 40 percent by the end of 2015. As a check, they also examined overall debt, and found that it varied by only a small amount between expansion and non-expansion states.
Note that this is a 40 percent reduction in total medical debt. Since Medicaid is available only to the poor, it’s a good bet that it’s reduced the medical debt of the poor by considerably more than 40 percent.
Trump is preoccupied with Hillary because she ruined his victory: he still can’t stand the thought that she got several million more votes than he did. I suspect the same is true of James Comey. Sure, he wanted Comey to help him out with the Michael Flynn investigation, but Comey’s real sin was being a living, breathing, daily reminder that Trump won only because Comey helped him out with his last-minute letter about the email investigation. This gnawed endlessly at Trump, so Comey had to go.
Russia’s ambassador to Washington told his superiors in Moscow that he discussed campaign-related matters, including policy issues important to Moscow, with Jeff Sessions during the 2016 presidential race.
….One U.S. official said that Sessions — who testified that he has no recollection of an April encounter — has provided “misleading” statements that are “contradicted by other evidence.” A former official said that the intelligence indicates that Sessions and Kislyak had “substantive” discussions on matters including Trump’s positions on Russia-related issues and prospects for U.S.-Russia relations in a Trump administration.
Sessions has said repeatedly that he never discussed campaign-related issues with Russian officials and that it was only in his capacity as a U.S. senator that he met with Kislyak.
….Officials emphasized that the information contradicting Sessions comes from U.S. intelligence on Kislyak’s communications with the Kremlin, and acknowledged that the Russian ambassador could have mischaracterized or exaggerated the nature of his interactions.
Where is this stuff coming from? If it’s coming from the intelligence community, color me disturbed. I don’t like the idea that the CIA and NSA are basically at war with the Trump administration. But if, instead, it’s coming from folks inside the White House, I’m astonished that anyone there would be interested in bringing down a hammer this colossal on Sessions. Do they want him to resign that badly? Or is it coming from former Obama officials who are just now getting around to leaking it?
Is there a single person in the Trump administration with any better morals than your average Mafia hood?
POSTSCRIPT: Here’s another thought. In his interview with the New York Times on Wednesday, Trump didn’t just gripe about Sessions recusing himself. He also remarked—without being asked—that Sessions had provided some “bad answers” to the Senate during his confirmation hearings. That struck me as an odd thing to say. Is it possible that Trump (a) knew about this intel, (b) knew it was going to get leaked soon, and (c) was deliberately distancing himself from Sessions before it happened?
I’ve been wondering when the Senate parliamentarian will rule on various provisions of the Senate health care bill, and apparently she already has. Today, Bernie Sanders released a summary of what’s in and what’s out. As you read this, keep in mind that the Byrd Rule allows a reconciliation bill to contain only provisions that directly affect the budget. If a provision only “incidentally” affects the budget, it needs to pass via regular order, which means it needs 60 votes—which means it’s dead. Here are the main provisions that are dead:
Abortion. The GOP bill contains two separate provisions that ban the purchase of health care policies that cover abortion. Freedom Caucus chair Mark Meadows says that killing these provisions makes passage “almost impossible.”
Planned Parenthood. This is a provision that prevents Medicaid from covering services provided by Planned Parenthood. Presumably this doesn’t pass muster because it doesn’t affect total spending, only where money can be spent.
Essential benefits. A provision in the Senate bill allows states to propose Medicaid alternatives that don’t cover essential benefits. However, this is merely a regulatory change, not something that changes overall spending.
CSR funding. This one is kind of ironic. The House has sued to stop the payment of CSR subsidies under Obamacare, and President Trump has deliberately refused to say if he’ll continue them. However, Republicans recognize how important they are, so they included them in their own health care bill. The parliamentarian struck down this provision because it duplicates something that already exists, which means it doesn’t affect the budget.
6-Month Lockout. This is the Republican replacement for the hated individual mandate. Instead of legally requiring everyone to buy insurance, they encourage everyone to buy insurance by mandating a waiting period if you fail to maintain continuous coverage. With this gone, there’s no longer any incentive to buy insurance. You might as well just wait until you’re sick and then buy it.
Medical Loss Ratio. This is a provision that does away with Obamacare’s mandate that insurance companies spend at least 80 percent of their revenue on medical care.
This stuff is deadly. Conservatives will hate the abortion and Planned Parenthood decisions. Insurers will hate the CSR and lockout decisions. Medicaid reformers will hate the essential benefits decision. And the end of the 6-month lockout provision will almost certainly have a big negative impact on the next version of the CBO score.
Why are corporations sitting on such big piles of cash? Why aren’t they investing more? Max Ehrenfreund points to a new bit of research with an intriguing answer: as firms merge, their market positions become so powerful they don’t need to bother. After all, why spend money if you don’t have to?
To investigate this, Germán Gutiérrez and Thomas Philippon took advantage of a natural experiment: the big rise in Chinese imports during the aughts. What they found was that in sectors that were highly affected by Chinese imports, firms increased their investment spending in order to compete. In sectors that were lightly affected, they didn’t bother:
(Note that this is a log scale, so the difference between the lines starting around 2005 is actually quite large.)
The authors suggest that the same thing has happened more generally. As sectors have become more consolidated, competition has dwindled and the need for heavy investment spending has dwindled too.
I don’t have the chops to evaluate this, but I’m sure others will chime in. However, it reinforces my belief that competiton is good for its own sake, and antitrust law needs to recognize this. We should move away from “consumer benefit” fables that corporations use to justify mergers, and instead insist on keeping sectors as competitive as possible.
From Patrick Murphy, owner of Bagel Barrel in Doylestown, Pennsylvania, on why he doesn’t want Obamacare repealed:
I can’t even remember why I opposed it. Everybody needs some sort of health insurance.
Answer: he opposed it because movement conservatives in the richest country in all of human history created a hysterical atmosphere of cultural doom and fiscal annihilation surrounding the idea of providing a minimal level of health coverage for everyone. Why did they do it? Why do they continue to do it? Even after seven years, I’m not sure I truly know.
Sean Spicer, the White House press secretary, resigned on Friday morning, telling President Trump he vehemently disagreed with the appointment of the New York financier Anthony Scaramucci as communications director.
Mr. Trump offered Mr. Scaramucci the job at 10 a.m. The president requested that Mr. Spicer stay on, but Mr. Spicer told Mr. Trump that he believed the appointment was a major mistake, according to a person with direct knowledge of the exchange.
On a purely personal level, I feel kind of sorry for Spicer, the same way I feel sorry for anyone who finally figures out just what kind of person Donald Trump really is.
On the other hand, it was pretty obvious all along what kind of person Trump was. Spicer knew, and he took the job anyway. I can excuse that for some of the national security folks, who might genuinely feel that they’re doing a public service preventing Trump from blowing up the world. But press secretary? No. If you want to wreck your reputation working for a clown like Trump, there’s no excuse. You went in with your eyes open.
POSTSCRIPT: Honestly, Spicer should have resigned after the Vatican snub. That was perhaps the pettiest thing I can ever remember a president doing to one of his staff. At a purely personal level, it shows what a horrible excuse for a human being Trump is.
For some reason, this is what I got when I typed "self driving car" into our photo service. As you can see, it is neither self driving nor a car. However, there really is a bear in the sidecar, so I decided to use it anyway.Visual via ZUMA
It’s rare to find an issue with true bipartisan consensus in Washington. But self-driving cars have been praised by members of both parties, who see the technology as a way to spur job creation while preventing many of the roughly 40,000 motor vehicle deaths that occur on American roads each year. According to the National Highway Traffic Safety Administration, 94 percent of traffic deaths involve human error, including distracted driving and driving while intoxicated.
The safety part I get. When they finally come, self-driving cars will almost certainly be safer than the 2-ton death machines that are currently piloted around our city streets by the texting/eating/singing/talking/shaving meat sacks that we laughingly refer to as sentient.
But job creation? How are self-driving cars going to spur job creation? Are we talking about the few thousand programmers and engineers who invent this stuff? Or what? Because when this technology becomes real, millions are going to lose their jobs as bus drivers, truck drivers, taxi drivers, and shuttle drivers.
Driscoll’s is so secretive about its robotic strawberry picker it won’t let photographers within telephoto range of it. But if you do get a peek, you won’t see anything humanoid or space-aged. AgroBot is still more John Deere than C-3PO — a boxy contraption moving in fits and starts, with its computer-driven sensors, graspers and cutters missing 1 in 3 berries.
….Driscoll’s, which grows berries in nearly two dozen countries and is the world’s top berry grower, already is moving its berries to table-top troughs, where they are easier for both human and machines to pick, as it has done over the last decade in Australia and Europe. “We don’t see — no matter what happens — that the labor problem will be solved,” said Soren Bjorn, president of Driscoll’s of the Americas.
AgroBot is still a prototype, but it’s getting better. And lots of other crops have already been mechanized:
Vast areas of the Central Valley have switched from labor intensive crops such as grapes or vegetables to almonds, which are mechanically shaken from the tree. The high-value wine grape industry has re-engineered the bulk of its vineyards to allow machines to span the vines like a monorail and strip them of grape clusters or leaves.
….It may be too late to mechanize asparagus. The crop, among the most labor-intensive in the state, has gradually shifted to Mexico since trade barriers made it cheaper to grow there, casting a nostalgic pall over Stockton’s asparagus festival.
This is what happens when immigration slows: jobs are either mechanized or offshored. Perhaps that was inevitable anyway. But if Donald Trump does build a wall and cut down substantially on illegal immigration, it’s unlikely to have more than a marginal effect on low-wage native workers. It will just mean more robots in the fields.
On the other hand, it will also mean we have fewer people in the US speaking Spanish. And that’s really the whole point, isn’t it?
Trump has asked his advisers about his power to pardon aides, family members and even himself in connection with the probe, according to one of those people….But one adviser said the president has simply expressed a curiosity in understanding the reach of his pardoning authority, as well as the limits of Mueller’s investigation.
He’s just curious! I mean, who wouldn’t be? Then there’s this:
Trump has been fuming about the probe in recent weeks as he has been informed about the legal questions that he and his family could face. His primary frustration centers on why allegations that his campaign coordinated with Russia should spread into scrutinizing many years of Trump dealmaking. He has told aides he was especially disturbed after learning Mueller would be able to access several years of his tax returns.
Those tax returns must really be toxic. I wonder what’s in them that Trump is so hellbent on keeping secret? It must be something pretty spectacular. Here’s the New York Times:
President Trump’s lawyers and aides are scouring the professional and political backgrounds of investigators hired by the special counsel Robert S. Mueller III, looking for conflicts of interest they could use to discredit the investigation — or even build a case to fire Mr. Mueller or get some members of his team recused, according to three people with knowledge of the research effort.
The search for potential conflicts is wide-ranging. It includes scrutinizing donations to Democratic candidates, investigators’ past clients and Mr. Mueller’s relationship with James B. Comey, whose firing as F.B.I. director is part of the special counsel’s investigation.
Trump seems to be treating this whole thing like a mob war. And maybe he’s right to do so. It just makes you wonder what he knows that we don’t.