• The Truth About Medicaid

    With the Senate health care bill finally out in the open, a tediously familiar game is unfolding once again. The game is to defend massive Medicaid cuts by claiming that Medicaid is useless anyway. In fact, maybe worse than useless. You see, people on Medicaid don’t have mortality rates any better than people with no insurance at all.

    This is tiresome, especially since it invariably comes from folks who have private insurance and would sooner cut off their big toes than give it up. My guess is that if they were suddenly poverty stricken, not a single one of them would choose to go uninsured rather than accept Medicaid.

    But that’s just my frustration talking. Instead, let’s talk facts. There are two big reasons why I find this nonsense so annoying.

    First, improving mortality is hardly the only goal of medical care. For most of us, it’s not even the main goal: the vast majority of doctor visits aren’t for life-threatening conditions. So even if it were true that Medicaid did nothing to extend lives, it still does plenty. If you get a toothache fixed, or your migraine headaches treated, or a meniscus repaired, it doesn’t affect your lifespan at all. But it sure makes you feel better. And if, in addition, it does this without subjecting you to $10,000 in debt and a horde of bill collectors on your ass 24/7, that’s pretty damn helpful too. Unless you’re explicitly looking for a cynical reason to claim that Medicaid is useless, you just can’t pretend that this stuff doesn’t matter.

    Second, the average age of adult Medicaid recipients is 38. At that age, there isn’t much mortality in the first place: less than 2 per thousand each year. To meaningfully distinguish mortality rates given such a low baseline you’d need a huge study. And it better be a pretty good one. General mortality (as opposed to mortality for, say, a chemotherapy drug) only makes sense if you follow a population for five or ten years. So it needs to be a long-term study. And it needs to account for the fact that the Medicaid population is different from the general population: poorer, sicker,¹ more stressed, more disabled, etc. I don’t know if any studies have ever been done that meet these criteria.

    However, there have been studies. Warts and all, they’re the best we have. The most famous is the Oregon Experiment, which is especially useful because it used genuinely identical treatment and control groups. However, each group consisted of only 10,000 people, which means the expected mortality in each group was 18 per year. That’s so low that the authors of the study couldn’t reach any conclusions at all about whether Medicaid had any effect on mortality. They did, however, draw null conclusions about other health indicators like blood pressure and cholesterol. The problem, again, is that the treatment group was so small that it’s hard to put much stock in this, especially since the study only lasted two years. However, if you nonetheless take their null conclusions about blood pressure and cholesterol seriously, you also have to take seriously their extremely positive results about depression, self-reported health, decrease in pain, and lack of financial catastrophe.

    Either way, that’s only one study. There have been others. A trio of researchers reviewed Medicaid studies recently in the New England Journal of Medicine, and came to these conclusions:

    The Oregon experiment found…significant increases in the rate of diagnosis of diabetes…along with a near-doubling of use of diabetes medications…. Meanwhile, the Oregon study found…a 30% relative reduction in rates of depressive symptoms.

    ….Multiple analyses have found improved self-reported health after the ACA’s coverage expansion, either in broad national trends or Medicaid expansion studies….Self-reported health is a validated measure of the risk of death….One study compared three states implementing large Medicaid expansions in the early 2000s to neighboring states that didn’t expand Medicaid, finding a significant 6% decrease in mortality over 5 years of follow-up….A more recent analysis of Medicaid’s mortality effects was one life saved for every 239 to 316 adults gaining coverage.

    ….One head-to-head quasi-experimental study of Medicaid versus private insurance, based on Arkansas’s decision to use ACA dollars to buy private coverage for low-income adults, found minimal differences. [That is, Medicaid was as effective as private insurance.]

    That’s pretty impressive, and it doesn’t even count aching teeth, repaired cartilage, treated migraines, or any of the hundreds of other routine things that don’t show up in studies of chronic conditions. Nor does it validate the frequent claim that Medicaid is useless because doctors won’t see Medicaid patients: most studies show that Medicaid patients did indeed see doctors when they needed to and were generally pleased with their treatment.

    That said, there’s a pretty obvious reason that Medicaid might not always produce dramatic differences compared to people with no insurance: by hook or by crook, the uninsured do get treatment for serious conditions. The main difference is that they have to pay for it. Here are the results of the Oregon experiment on the finances of the folks who were chosen to receive Medicaid:

    Adults on Medicaid had 81 percent fewer catastrophic expenses. And in this case, the methodology of the Oregon Experiment is fine. A sample of 10,000 is plenty big and a timeframe of two years is plenty long. These are not things that affect only a tiny percentage of people, or that need years to show an effect. In addition to its medical benefits, Medicaid is a financial godsend for poor people.

    One final thing: the folks who claim that Medicaid is useless never provide any feasible mechanism for this. Statistical studies are fine, but if they really do show null results for Medicaid coverage, there has to be some plausible reason why it produces no results. If we assume that medical care in general has positive results, why wouldn’t Medicaid? It may not provide the quality of care of private insurance, but it’s hardly the domain of quacks and shysters. It pays for care by real doctors and real hospitals, and it would be remarkable if that care really did no one any good. So what’s the theory here?

    None of this means that Medicaid is perfect. It reimburses too little and really does seem to fail on some measures. It’s a serious drain on state budgets. And it has other problems as well that we ought to address. Liberals and conservatives alike should be dedicated to continually improving it.

    Of course, speaking for myself, I’d love to eliminate Medicaid. And Medicare. And Obamacare. And employer insurance. A simpleminded national health care system would cover more people, almost certainly cost less than our current hodgepodge, and produce better results than what we get now. But that’s pie in the sky in this particular political moment. Given the reality of what we have, Medicaid is a critical part of our health care hodgepodge. Slashing it in order to give a big tax cut to the rich is obscene.

    ¹You may be surprised to learn that low reimbursement rates aren’t the only reason doctors are reluctant to see Medicaid patients. It’s a big factor, but nearly as important is that Medicaid patients take up so much time. This is because they’re generally sicker than other patients. So doctors are getting paid half as much for patients who have much more complex medical needs than average. The general stress of being poor accounts for some of this, but lack of consistent health care over their lifetime probably accounts for most of it.

  • Trumpcare Will Bring Chaos to Health Care Market

    The LA Times reports on the Senate health care bill:

    Congressional Republicans, who for years blasted the Affordable Care Act for disrupting Americans’ healthcare, are now pushing changes that threaten to not only strip health coverage from millions, but also upend insurance markets, cripple state budgets and drive medical clinics and hospitals to the breaking point.

    ….The cascading effects of such a retrenchment will reach far beyond those who lose coverage, according to doctors, hospital leaders, insurance executives, patient advocates and state officials across the country….Governors and state legislators, facing huge reductions in federal Medicaid funding, may soon have to decide whether to reduce services, limit who can enroll in the healthcare safety net or make cuts to other state programs, such as education or transportation….Those coverage losses, in turn, will put new pressures on doctors, clinics and hospitals as they face growing numbers of patients with no insurance who are unable to pay their medical bills.

    ….The strain on hospitals and doctors will reach beyond the healthcare system. American employers, which provide health coverage to more than 150 million workers and their families, could see their costs rise as hospitals and physicians try to make up for losses they incur caring for more uninsured patients….It also will probably hit employees, who will see insurance premiums increase and wages stagnate as businesses shift healthcare costs onto workers, as has happened repeatedly in the past.

    Republicans have been saying for seven years that they want to repeal Obamacare, so I can hardly pretend to be surprised that they’re doing it after winning the 2016 election. But now that it’s actually happening, I still find it hard to believe. What kind of people do this just so the rich can get a modest tax cut? How cold-blooded do you have to be? Especially when Obamacare’s modest problems could be fixed with nothing more than a few minor changes and additional funding of $5-10 billion or so. Of course, if we did that the millionaires wouldn’t get their tax cut.

    This whole thing is just profoundly depressing. What the hell kind of country is this?

  • Over 50? Trumpcare Will Raise Your Premiums $4,500.

    The Kaiser Family Foundation has figured out what the net premiums would be under the Senate health care bill for all 3,143 counties in the United States. For folks in their 20s, premiums go down in most places by an average of a few hundred dollars. For people in their 40s, 50s, and 60s with modest incomes, premiums go up—in most cases by thousands of dollars.

    The net premium is the cost of coverage minus the tax credit subsidy. For you quantitative types who like to see your data in chart form, here it is for a working-class 60-year-old. There is one (1) county in the entire country that sees a net reduction:

    And for you visual types, here it is in map form:

    And keep in mind that with the end of protection for essential benefits and the elimination of CSR subsidies, these higher premiums are almost certainly paying for worse coverage, higher deductibles, and higher copays.

  • Twitter Is a Cesspool, But It’s Our Cesspool

    Poor Bret Stephens. He’s the latest punching bag for the left among New York Times columnists, and apparently he’s getting sick of it. “Twitter is about the naked, grunting brain,” he says. “It’s whatever pops out. And what pops out is altogether too revealing.” So he’s quitting Twitter.

    There’s not much question that Twitter is a cesspool, but I think he’s making a mistake nonetheless. A lot of people blame social media for making our politics cruder, but that misses the reality. Our politics has always been this crude. We just didn’t know it. All Twitter has done is expose our collective id in a way that’s hard to brush off.

    This is difficult to accept. Is this really what America is like in the privacy of our own thoughts? Yes it is. There’s no point in denying it. The question is, are we better off knowing it, or were we better off when we all pretended to be better people than this?

    I’m not sure. There are surely advantages to norms of civility in public life. A Burkean conservative would probably say that those norms have been developed over a long time and we should respect the fact that we’ve historically found them useful. However, one thing Twitter (and Donald Trump) have demonstrated is that there are damn few Burkean conservatives in the United States. Conversely, a liberal would presumably believe that it’s important to know the raw truth. On the other hand, it’s liberals who are the biggest complainers about the rampant sexism, racism, xenophobia, and so forth that are so common on Twitter.

    As for myself, I have an unusual attitude toward this stuff: it doesn’t bother me much. In fact, it kind of amuses me, which is why I’ve never blocked anyone. I get a little bit of a kick out of seeing the tidal wave of idiocy that comes my way periodically when someone gets pissed off for one reason or another and brings along a troll army.

    Of course, I’m white, male, straight, and sort of emotionally stunted. So I don’t get burning crosses sent my way, or threats to rape me, or piles of people telling me to get the hell out of the country. The stuff I get is plenty nasty, but in a generic sort of way—and since I have stunted emotions it never upsets me that much. In fact, it’s kind of useful to know how idiots feel about stuff, since I don’t spend much time with idiots in my day-to-day life.

    This could all change, I suppose. One thing I find odd is how uncreative Twitter trolls are. There are things that would provoke me, but they never seem to have any clue what they might be. They just stick with all-purpose insults that are so dumb it’s hard to believe anyone actually being upset by them. I wonder if they’ll ever get smarter?

    Probably not. After all, they’re idiots. If they were smart, they wouldn’t be doing this kind of dogpiling in the first place. In the end, I think this is what will save Twitter. There’s only so much damage that idiots can do, and I think we already know what it is.

  • Senate Republicans Are Ready to Repeal Obamacare

    This is just a note about the Senate health care bill. Do not believe any prattle about Mitch McConnell “being OK with a loss.” Or about “moderate Republicans” who will vote against it. Or about conservatives who are “revolting.” Or about “desperate attempts” to hold the Republican caucus together.

    Next week the CBO will release its score of the bill. They will confirm that it doesn’t increase the deficit. The Senate will debate for a day or two; pass a few minor amendments; and then pass the bill. The vote will be 51-50, with Vice President Pence breaking the tie.

    If Paul Ryan is smart, he will simply bring up the Senate bill for a vote and be done with it. It will pass because everyone will understand that this is their only chance. Either vote yes, or else give up on repealing Obamacare and give Democrats a big win.

    The only way to break this cycle is to generate some new opposition. Senate Republicans already know that Democrats oppose the bill, AARP opposes the bill, hospitals oppose the bill, and so forth. They don’t care. The Democrats won’t vote for them no matter what they do and the others aren’t threatening to withdraw campaign support. They oppose the bill, but only on paper. They also know that their bill will take away health coverage from millions. They don’t care about that either. They never have.

    This is it. There’s a week left. Lefties need to generate some new opposition to the bill that wavering senators are actually afraid of. Any ideas?

  • Friday Cat Blogging – 23 June 2017

    Catblogging is a few minutes early this week because I have to drive Marian to the airport. She’s flying to Colorado via Phoenix, where it’s a balmy 112º today. Apparently this means that the tarmac won’t melt the wheels of her plane, so everything should be hunky dory.

    In cat news today, Wim Van Neer of the Royal Belgian Institute of Natural Sciences in Brussels has been collecting ancient cat specimens for the past decade and putting them through the genetic wringer. His conclusion: “It was the Egyptians who turned them into the lovable fur balls we know today.” Thanks, Egyptians!

  • Liberals and Immigration

    A couple of days ago I wrote a post responding to Peter Beinart’s recent article about Democrats and illegal immigration. It was a bit of a dog’s breakfast. I intended to write one thing and then ended up writing something else, which made the post a little disjointed. Then it turned out I’d made an arithmetic mistake, and had to rewrite a chunk of the piece on the fly. Blecch.

    But I did promise to eventually write the piece I initially had in mind, so here it is. I’m a little pressed for time, so I’ll keep it short.

    Statistics aside, one of Beinart’s main points was not that liberals should become big opponents of immigration, but that they should be willing to admit that there are drawbacks as well as benefits to large flows of illegal immigration. It’s complicated, and everyone should be willing to admit it.

    I agree completely, and this is hardly a problem limited to immigration. I blame it mostly on conservatives, but I imagine conservatives blame it mostly on liberals, so I’ll skip trying to assign blame. Either way, the upshot is that there never appears to be any political advantage to admitting that an issue has both upsides and downsides. But every issue important enough to be worth talking about does. It’s just that there’s hardly any audience left that cares.

    I have no idea what, if anything, we can do about this. But I will say this. I lurk on a number of message boards populated by liberals, and what they say privately is very often more nuanced than what they say publicly.¹ On immigration, there are probably lots of liberals willing to concede that there needs to be a limit to the flow of undocumented workers. There are cultural, economic, and nationalistic reasons for this. But there’s little benefit to saying so in public. It just invites massive, social media swarms insisting that you’re a closet racist.

    I’ve long been on record as a moderate liberal on immigration. I think there are benefits to keeping illegal immigration to a modest level,² and details aside, I think the way to do this is a rigorous version of E-Verify along with tough employer sanctions. In my own personal utopia, I’d pair this up with a national ID card. Basically, if undocumented immigrants can’t get jobs, they’ll stop coming. There’s no need for a wall.

    I wonder how many liberals agree with me, more or less? I wonder how many are waiting for someone else to say it before they do? I wonder how many just flatly don’t consider it worth the blowback, so they stay quiet? Questions, questions.

    ¹As you might imagine, this is partly because the boards I’m attracted to aren’t run by shouters and nutballs. Still, I’m curious: is the same true of moderate conservative boards? Any wingers out there care to comment?

    ²And drawbacks to getting too tough on illegal immigration. There are good reasons to protect our borders, but there economic, humanitarian, and police state reasons not to have a goal of zero illegal immigration.

  • Republicans: Comey Is a Liar

    NBC News asked Americans who they believe: Donald Trump or James Comey. The results are pretty much America in a nutshell:

    Democrats and Republicans live in different worlds. Democrats believe Comey by a margin of +74 percent. The Republican margin is -40 percent. That’s a difference of 114 percent. I’m not sure I’ve ever seen a partisan gap that wide on anything.

    But I guess it’s no surprise. If you get your news from Fox and Drudge and talk radio, it’s obvious that Comey is just a big fat liar who has it in for Trump. It’s Spock’s beard at work.

  • My Thoughtful Critique of Trumpcare

    Avik Roy has a request:

    OK, here’s my Top 5 list:

    1. Medicaid: The Senate bill slashes spending on Medicaid in order to cut taxes on the rich. This is a cruel and unnecessary tradeoff for the richest country in the history of the world.
    2. Death Spiral: It eliminates the individual mandate; reduces subsidies for the poor; reduces benchmark plans to an actuarial value of 58 percent; and increases deductibles and copays. Whatever instability Obamacare currently has, this will make it far, far worse.
    3. Essential Health Benefits: Like the House bill, the Senate bill makes it easy for states to cut essential health benefits, which motivates insurers to offer low-end policies for the working poor that are worthless—but only if you read the fine print.
    4. More Uninsured: It will lead to tens of millions fewer people having health coverage. CBO will provide an exact number in a few days, but we already know it’s going to be big.
    5. Lifetime Caps: Guts protections against annual and lifetime caps, and because of the way the bill is written, it’s likely to do this even for employer insurance, not just for the individual market.

    There’s more, like the substantial increase in premiums for older workers and the quiet kickback to insurance company CEOs. And what are the benefits? Unless you’re rich or you really, really want to cut funding for Planned Parenthood, it’s hard to see any.

  • Saudi Arabia Demands Qatar Shut Down Al Jazeera

    From the Wall Street Journal:

    Saudi Arabia and other Arab states that have severed ties with Qatar issued a list of severe demands to end the worst regional diplomatic crisis in years, telling their Persian Gulf neighbor to close state broadcaster Al Jazeera, curb ties with Iran and end Turkey’s military presence on its soil….The government of Tamim bin Hamad Al-Thani has 10 days to accept the demands, which include paying reparations and providing information on all opposition groups it has supported, the document says, without specifying what penalties the Saudi-led group will impose if Qatar fails to comply.

    And there you have it. Does Saudi Arabia really care about Qatar’s tightrope walk relationship with Iran, which it shares a gigantic gas field with? Or the 200 Turkish troops in Qatar? Or its ties to Hezbollah and the Muslim Brotherhood?

    Well, sure, they care. But Qatar is just pursuing standard small-country diplomacy, trying to balance its alliances so it doesn’t become a client state of the local hegemon. It’s hardly a threat to Saudi Arabia.

    But Al Jazeera is, because it provides a view of the outside world to ordinary Saudi citizens that’s not controlled by the Ministry of Keeping Everyone In Line. That’s really the only thing Qatar does that’s truly threatening.

  • WaPo: Putin Personally Ordered Campaign Interference to Help Trump

    Metzel Mikhail/TASS via ZUMA

    Never forget:

    Early last August, an envelope with extraordinary handling restrictions arrived at the White House….Inside was an intelligence bombshell, a report drawn from sourcing deep inside the Russian government that detailed Russian President Vladi­mir Putin’s direct involvement in a cyber campaign to disrupt and discredit the U.S. presidential race.

    But it went further. The intelligence captured Putin’s specific instructions on the operation’s audacious objectives — defeat or at least damage the Democratic nominee, Hillary Clinton, and help elect her opponent, Donald Trump.

    ….The White House turned to Congress for help….But Republicans resisted, arguing that to warn the public that the election was under attack would further Russia’s aim of sapping confidence in the system.

    Senate Majority Leader Mitch McConnell (R-Ky.) went further, officials said, voicing skepticism that the underlying intelligence truly supported the White House’s claims. Through a spokeswoman, McConnell declined to comment, citing the secrecy of that meeting.

    Key Democrats were stunned by the GOP response and exasperated that the White House seemed willing to let Republican opposition block any pre-election move.

    This is from the Washington Post. Read the whole thing.

  • Republicans Are Mean

    Here’s a story for you. My mother grew up in a Republican family.1 When Herbert Hoover was on the radio, everyone listened. But later she became a Democrat. What happened?

    Well, she went off to college. But not some bleeding heart lefty bastion. She went to USC, which was even more Republican in 1950 than it is now. She didn’t get indoctrinated by a bunch of fuzzy liberal professors.

    So what caused the switch? I asked her once, and she said that during her college years she came to the conclusion that Republicans were just mean. So she became a Democrat.

    This struck me because I’ve long used the exact same word in the privacy of my own thoughts. I can write a sophisticated critique of conservative ideology as well as the next guy, but the truth is that it mostly boils down to a gut feel that Republicans are mean. I’ve never said this out loud because it sounds so kindergarten-y, but there it is. I think Republicans are mean, just like my mother did.

    But now our time has come. Donald Trump started it, with his contention that Paul Ryan’s health care bill was “mean.” Today, Barack Obama picked up the ball, writing on Facebook about the “fundamental meanness at the core of this legislation.” And then Chuck Schumer weighed in with a big red poster calling the Senate health care bill “meaner.”

    So that’s that. It’s now OK to ditch the ten-dollar words and just spit it out. Republicans are mean.2

    1I’ve never figured out what the deal was here. My grandfather was very much a working-class guy, an electrician for Western Union. But he hated FDR. I don’t know why.

    2The weird thing about this is that I live in Orange County and I know lots of conservatives. For the most part, they aren’t mean. But put ’em together in a single political party, and it’s all torches and pitchforks.

  • Our Score So Far: Republicans 89, Democrats 1

    This comes via a 4th-grade friend, who got it from some guy on Facebook, who probably got it from Daily Kos, who got it from Wikipedia:

    In the criminal convictions contest, the score is Republicans 89, Democrats 1. And that’s not even counting all the high-level Iran-Contra folks who probably would have been convicted of various felonies if they hadn’t been pardoned by GHW Bush.

    Among Democrats, there’s been only one criminal conviction in the past 50 years. The unlucky schmoe is Ron Blackley, who was collateral damage from a special prosecutor who even Ken Starr thought was kind of nuts. The guy ran amuck in a futile attempt to pin something on Secretary of Agriculture Mike Espy,1 and in the process he managed to win a perjury conviction against Blackley, who served as Espy’s chief of staff, for failing to disclose a pittance in consulting fees from a former consulting business in Mississippi.

    I wonder if Donald Trump can break Nixon’s record? One thing going against Trump is that he’s barely able to hire anyone these days, and you can’t garner lots of corruption convictions if you don’t have anyone working for you. On the other hand, he’s Trump. You never know.

    1He got a grand jury to hand down a bunch of indictments, but his case was so thin that Espy didn’t even bother mounting a defense. The jury acquitted Espy of everything.

  • Lunchtime Photo

    A field of California poppies at sunset, as the flowers start to close up for the night. You are getting sleepy, sleepy….

  • Five Ways the Senate Health Care Bill Raises the Cost of Insurance

    The Senate health care bill takes an axe to Medicaid, but it also does a ton of damage to private insurance purchased on the exchanges. It does this in five ways:1

    • Tax subsidies are reduced right out of the gate by changing the benchmark used from “second-lowest cost silver plan” to “applicable median cost benchmark plan.” The “applicable” median plan has an actuarial value of 58 percent, compared to a minimum of 70 percent for a silver plan. This makes it much cheaper, and thus makes the benchmark subsidies lower.
    • Subsidies stop entirely at an income of about $42,000, compared to $48,000 currently.
    • The age band is increased from 3:1 to 5:1, which will increase premiums for older workers.
    • Obamacare’s essential health benefits are eliminated, which allows insurers to offer crappier insurance.
    • CSR subsidies are eliminated, which will substantially increase deductibles and copays for poor people.

    The end result of all this is that subsidies will go down, coverage will get worse, and deductibles and copays will get higher. Older people will also see an increase in their premiums.

    How much does all this add up to? Quite a bit, I’m sure, but we’ll have to wait for the CBO score to put a solid number on it.

    1That’s how many I’ve discovered so far, anyway. There are probably other little gems hidden inside the bill that I haven’t caught. I’ll add them to the list when I hear about them.

    UPDATE: My original post used the wrong excerpt of the bill to illustrate the elimination of essential benefits. It’s actually part of something called a “1332 waiver,” which allows states to apply for an exemption to some of Obamacare’s requirements. Among other things, this exemption can include essential benefits.

  • CNN: Trump Asked Intel Chiefs to Publicly Exonerate His Campaign

    From CNN:

    Two of the nation’s top intelligence officials told Special Counsel Robert Mueller’s team and Senate investigators, in separate meetings last week, that President Donald Trump suggested they say publicly there was no collusion between his campaign and the Russians, according to multiple sources.

    Director of National Intelligence Dan Coats and National Security Agency Director Adm. Mike Rogers described their interactions with the President about the Russia investigation as odd and uncomfortable, but said they did not believe the President gave them orders to interfere, according to multiple sources familiar with their accounts.

    This goes further than what Trump asked James Comey to do. He wanted Comey to publicly acknowledge that Trump himself wasn’t under investigation, which was at least true. But he apparently asked the intelligence chiefs to say that his campaign didn’t collude with the Russians, which is precisely what’s under investigation. That’s like asking the district attorney to publicly exonerate a murder suspect while police are still collecting evidence.

    This may not have been an order to interfere with an ongoing investigation, but it was sure as hell inappropriate, as both Coats and Rogers obviously knew.

  • New Study Suggests Police Stop Minorities at Moderately Higher Rates Than Whites

    The Stanford Policing Project is a massive effort to collect data on police stops nationwide. It’s basically an attempt to find out whether police unfairly stop and search blacks and Hispanics at greater rates than whites, and they’ve now released the data they have so far.

    What they find is that police stop Hispanics at about the same rate as whites, but stop blacks at a somewhat higher rate. Once stopped, both groups are ticketed, searched, and arrested at significantly higher rates than whites. But is this because of racial discrimination? The Stanford researchers used two different tests to find out.

    First up is what’s called an “outcome test.” If, say, police search blacks at twice the rate of whites, but also find contraband at twice the rate, it suggests there’s no bias in who they choose to search. They’re using a roughly equal standard of suspicion for both. Here are the results of that test. Note that the dashed black line represents white searches, while the dashed red line is my eyeball guess at the difference for blacks and Hispanics:

    Although police search blacks more often than they search whites, they find contraband at about the same rate. They appear to be using similar criteria for both. However, they find contraband at a lower rate in searches of Hispanic drivers. This suggests they’re using a tougher standard of suspicion against Hispanics.

    But that’s not all. There’s also something called a “threshold test.” This is a more direct measure of the standard police use to search drivers they stop. Here are the results:

    When this more sensitive test of outcomes is applied, it shows that the threshold for a search is lower for both blacks and Hispanics. Very roughly speaking, it appears that police need about a third less suspicion to search black and Hispanic drivers compared to white drivers.

    I’m not sure how this compares to previous studies. My initial sense is that it’s less than I would have guessed. Overall, police do stop and search black and Hispanic drivers at unfairly high rates, but not at enormously higher rates—although it’s obvious that in certain communities the stop rate of minority drivers is far, far higher and the standard of suspicion is far, far lower than it is for white drivers:

     We’ll certainly find out more about this in the future, since the Stanford researchers have placed their massive database online and made it available to anyone who wants to dive more deeply into the data. They also continue to collect information from police departments around the country.

  • Senate Health Bill Would Wreck the Individual Insurance Market

    This is tentative, but….

    I’ve just taken a quick look at the Senate health care bill. Neither preexisting nor continuous are anywhere in the bill. None of the section titles deal with preexisting conditions. It doesn’t appear that the Senate bill affects Obamacare’s protections for preexisting conditions at all. This is almost certainly because the Senate parliamentarian ruled that it had nothing to do with spending or outlays, and therefore couldn’t be included in a reconciliation bill.

    The Senate bill also abolishes Obamacare’s individual mandate penalties. The net result is that if this bill passes, people will be free to go without insurance while they’re healthy, and then buy insurance if and when they get seriously ill. This is a disaster for the health insurance industry.

    I don’t see how insurance companies can continue to dither at this point. The Senate bill would almost certainly be a huge financial blow to anyone who stays in the individual insurance business, and since the wording is driven by reconciliation rules it means that any final bill negotiated with the House would have to be the same. They can’t possibly accept this, can they?

  • Senate Health Bill Finally Drops, and It’s a Huge Giveaway for the Rich

    Thirteen senators have labored mightily and brough forth a mouse. The Senate version of Obamacare repeal dropped today, and it’s pretty much the same as the House version:

    • It’s a huge tax cut for the rich.
    • It slashes Medicaid for the poor.
    • It allows states to cut back on essential benefits.
    • It abolishes the individual mandate.

    Unlike the House bill, it keeps Obamacare’s income-based subsidies, which makes it a little more friendly to the working poor. However, it also cuts back on those subsidies.

    I’ll have more details later as they become available. But the bottom line is pretty simple: it cuts a trillion dollars in taxes on the rich, which means it also cuts a trillion dollars in spending on the poor and working class. That’s simple arithmetic. As a result, it’s going to take health insurance away from a lot of people. It might be 23 million, like the House bill, or it might be slightly more or slightly less. The CBO will tell us in a few days. But whatever the answer, this is pretty much the same horrific bill that the House has already passed.

    One other note: I don’t know yet how it handles pre-existing conditions. Thanks to reconciliation rules, I don’t think it can change them much. More on this later.

    Watch Elizabeth Warren tear into her Republican colleagues in the Senate.

    I am sick of explaining this to Republicans

    Women aren’t fools. We can tell the difference between reality and lies. And that’s why we’re here, fighting back on the Senate floor, to stop the Republican health care bill.

    Posted by U.S. Senator Elizabeth Warren on Wednesday, June 21, 2017

  • Liberals Haven’t “Lost Their Way” On Immigration

    Over at the Atlantic, Peter Beinart laments that liberals have become too doctrinaire over the past decade in their defense of illegal immigration:

    Prominent liberals didn’t oppose immigration a decade ago. Most acknowledged its benefits to America’s economy and culture. They supported a path to citizenship for the undocumented. Still, they routinely asserted that low-skilled immigrants depressed the wages of low-skilled American workers and strained America’s welfare state. And they were far more likely than liberals today are to acknowledge that, as Krugman put it, “immigration is an intensely painful topic … because it places basic principles in conflict.”

    Today, little of that ambivalence remains. In 2008, the Democratic platform…referred three times to people entering the country “illegally.” The immigration section of the 2016 platform didn’t use the word illegal, or any variation of it, at all.

    Why did the left move even further left on immigration? Beinart chalks it up to politics: Democrats began to believe they’d dominate elections forever if they could sew up the Hispanic vote, and that motivated them to become ever less compromising on issues important to their Hispanic base.

    I suppose that’s part of it, but I’m surprised that Beinart doesn’t mention the obvious: there have been two big attempts in the past decade to pass a moderate, compromise immigration bill. The first time was in 2006, when both the House and Senate passed bills by large margins. But thanks to a backlash from talk radio and social conservatives, the bills never went to conference and the effort died.

    The second time was in 2013. A bill passed the Senate by a large, bipartisan majority, but once again it hit a backlash from the tea-party wing of the Republican Party. John Boehner never allowed the bill to come up for a vote in the House, and the effort died again.

    These two episodes have made it clear that compromise on immigration is pointless. That being the case, why bother playing Hamlet about the effect of illegal immigration on the wages of low-skilled natives? Especially since it’s largely a red herring anyway: it’s true that undocumented immigrants have an impact on the wages of low-skill native workers, but the effect is pretty moderate.

    UPDATE: My initial post used the wrong numbers for the effect of immigration on wages. The estimates below, along with the chart, have been corrected. Thanks to Jason Richwine for pointing out the error.

    Beinart repeatedly mentions the findings of a National Academies of Sciences report on immigration and the economy, but never mentions the precise number it comes up with: for low-skill native workers, an average of all studies suggests that an influx of even a million immigrants would only lower wages about 4.6 percent in the short run.1

    The same is true for state and local spending. The NAS report estimates that new immigrants cost states a net of about $1,600 per year.2 This means that an influx of a million immigrants would create a net burden of $1.6 billion. That’s less than one-tenth of one percent of all state and local spending. It’s a rounding error.

    These numbers are small, and are used mostly as intellectual cover by opponents of illegal immigration. They are not even remotely the reason for opposition to comprehensive immigration reform, which comes mostly from educated native whites whose wages and taxes aren’t impacted more than a hair by illegal immigration. The real reason is almost purely cultural: dislike of non-English speakers, an inchoate fear of crime, and a vague sense that white America is fading away. But hardly anyone wants to admit that these are the real terms of the argument.

    Quite a bit of new research has been done over the past decade, and the result has been, if anything, a reduction in the perceived economic effects of illegal immigration. The wage effects are roughly zero overall, and even for low-skill workers are fairly small in the short run—and get smaller over time. The fiscal effects are even smaller, and become zero over the long run. Given all this, it’s hardly a surprise that supporters of comprehensive immigration reform no longer give economic arguments much attention.3

    1This is the average of all studies in Table 5-2 that focus on high school dropouts. The mean result was a wage effect of -0.56 percent for an increase in the low-skill labor supply of 1 percent, which amounts to about 120,000 workers. That comes to -4.66 percent per million new immigrants.

    2Table 9-6.

    3This is not the post I intended to write when I started out. But after reading the NAS report, it’s the one I ended up with. Maybe tomorrow I’ll write the post I originally had in mind.