Kevin Drum

Health Update

| Sat Jul. 25, 2015 8:54 PM EDT

This has come up in comments a few times recently, so here's a quick update.

Short answer: I'm fine.

Slightly longer answer: As I mentioned a few weeks ago, I didn't respond to the stem cell transplant, so we're trying a new chemo med. The good news is that I don't seem to be suffering any side effects so far. But it often takes more than a month for these things to show up, so we're not out of the woods yet. As for whether it's working, it will be several more months before we know.

All that aside, I feel pretty good these days. Not totally back to normal, but 80-90 percent of the way there. I still have a bit of mild stomach nausea periodically, and my neuropathy shows no signs of going away, but my energy level is pretty good and I'm eating enough for two people. At the moment, my only real problem is that I'm tired from not getting enough sleep. But that's nothing to worry about. I've been taking sleep meds for the past six months, and wanted to wait until I was feeling better to get off them. That time has come, so I'm tapering off under my doctor's instructions. It's actually going better than I expected, but there's still a price to pay. Until my body gets back into the habit of falling asleep and staying asleep on its own, I'm going to be a little short on shuteye. With any luck, this will only last a few more weeks.

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Republicans Is Weird, Summer 2015 Edition

| Sat Jul. 25, 2015 12:29 PM EDT

No, this isn't about Donald Trump. It's about Sen. Mike Lee of Utah—who plans to offer yet another amendment to repeal Obamacare, but this time with a special super-duper secret sauce added to the upcoming highway funding bill:

Lee said he will try to re-offer the Obamacare repeal as a special amendment that is directly related to highway funding. Under Senate rules, amendments that are directly related, or germane, to the underlying legislation can pass with just 51 votes.

Lee knows that the chair of the Senate is likely to reject his logic that Obamacare repeal is germane to highway funding, so he plans to use the nuclear option. That means he will formally object to the ruling of the chair, which requires a 51-vote simple majority — then he plans to move on to the coveted simple majority vote.

....If his plan works, Lee gets to tell his supporters that he’s responsible for a major vote to kill the health care law he reviles. The House voted to repeal the law in February, so the two chambers could then theoretically conference the bills — leaving it up to Obama to veto a bill to kill his own signature policy achievement.

So the plan is simple: have Republicans declare ex cathedra that repeal of Obamacare is germane to highway funding, and then pass Lee's amendment with 51 votes. It's brilliant! All that's missing are the sharks with lasers attached to their heads!

Aside from being mind-numbingly stupid1, it also won't work. Democrats will just filibuster the entire highway bill, or else they'll vote for it and then Obama will veto the entire mess. Result: Obamacare stays in place but our highways continue to crumble into dust. Nice work, Senator! It's good to see that the Republican Party remains committed to the sober, responsible kind of leadership that makes our great nation the envy of the world.

1It's times like this that I regret the recent banishment of "retarded" from polite conversation. Because I think we all know that it's the word that really fits here.2

2Though I suppose there's no reason to insult the developmentally disabled by comparing them to Mike Lee.

Friday Cat Blogging - 24 July 2015

| Fri Jul. 24, 2015 2:45 PM EDT

Hopper and Hilbert like to (a) play-wrestle with each other, and (b) jump up on the fireplace mantel. Here they are doing both. Hopper has lately been taking control of these affairs, finally realizing that she's the real alpha cat in the household even if her brother is bigger. As she's finally figured out, being alpha is more about will and energy than about size, and she's got both. Nonetheless, you can see in this picture about how seriously she takes it.

Cigna-Anthem Merger Might Not Be a Bad Deal for Consumers

| Fri Jul. 24, 2015 2:08 PM EDT

There used to be five big health insurance companies in the US. If the proposed Anthem-Cigna merger goes through, we'll be down to three. Is this a good thing? Wonkblog's Carolyn Johnson reports:

The effect on premiums are hard to predict, but are likely to be bad.

The question of how the mergers will affect card-carrying members is more complicated than it might seem. In general, consolidation in an industry leads to less competition and higher prices. Indeed, the few studies that have been done suggest that fewer insurers in the marketplace will mean higher prices.

...."The premise of the merger for both of these transactions is that they can achieve cost savings and economies of scale, and they of course maintain that will lead to their ability to price even more competitively," said Richard Zall, chair of the health care department at Proskauer, a law firm. "It will take some time to see: 1) can they implement the mergers and achieve those savings and 2) is there still sufficient competition in the various markets that it won’t lead to price increases?"

Actually, it's not this simple. There are several things that make it hard to predict how this will shake out:

  1. Health insurers do compete with each other, but even more they compete with providers (doctors, hospitals, drug companies, etc.). If there are multiple small insurers in, say, Kansas, then hospitals there have a lot of pricing power. If an insurer refuses to do business with a particular hospital, that puts them at a big disadvantage compared to their competitors and limits their leverage to negotiate lower prices. But if there are only one or two big insurers, it's the hospitals that are at a disadvantage since they can't afford to be out of their networks. In this case, insurers have much more leverage to negotiate lower prices.
  2. Unlike, say, diet colas, which are available everywhere, even big health insurers tend to be somewhat regional. This means there are some areas where there's literally only one insurer available. This obviously could put consumers at a disadvantage.
  3. However, Obamacare mandates a minimum "medical loss ratio" of 80 percent. Even if there's only one insurer in a county, they have to spend at least 80 percent of their premium dollars on actual health care. That number goes up to 85 percent for large group plans. So there's a hard limit on how much insurers can charge no matter who controls the market.
  4. Generally speaking, we liberals would prefer a system in which there was only one insurer: the federal government. There are various reasons for this, but one of them is that a single nationwide insurer would have enormous pricing power. This is sort of the ultimate version of item #1. Medical costs are overwhelmingly set by providers, not by insurers, and the more leverage insurers have, the lower prices are for consumers.

In other words, while I'd normally be opposed to such severe consolidation in an industry, it's a little trickier in this case. There are plenty of horror stories about health insurers, but when it comes to pricing, a smaller number of bigger insurers is probably a good trend. In the health care industry, the thing to be worried about is consolidation on the provider side. That would be bad for medical costs.

Hillary Clinton Takes Aim at Capital Gains Taxes for the Rich

| Fri Jul. 24, 2015 11:43 AM EDT

The Wall Street Journal reports that Hillary Clinton's tax plan is starting to take shape:

Hillary Clinton will propose a sharp increase in the capital-gains tax rate for the highest earners for investments held only a few years, a campaign official said Friday. Under the Clinton plan, investments held between one and two years would be taxed at the normal income-tax rate of 39.6%, nearly double the existing 20% capital gains rate.

....The rate for top-bracket taxpayers would be set on a sliding scale, with the lowest rate applied to investments held the longest. To qualify for the existing 20% rate, one would have to hold an investment for at least six years.

This change would apply only to high-income taxpayers and only to short-term investments. Lower-income workers would continue to get a break on capital gains taxes compared to the rate they pay on ordinary income. This is mostly for show, however: low-income workers barely have any capital gains income in the first place. The chart on the right from the Tax Policy Center shows the breakdown. Anyone making less than a six-figure income pays virtually no capital gains taxes, so changing their rates serves no purpose. It's only at the high end of the income spectrum that the preferential capital gains rate matters.

Hillary's proposal will enrage conservatives, who are convinced that capital gains rates are the magic key to prosperity. Since there's virtually no evidence linking capital gains rates to economic growth, the cynical among you might think that what really motivates their tireless advocacy of low rates is that it benefits the rich enormously. But that's only for the cynical among you.

In any case, folks who make more than a million dollars a year are going to be pretty exercised about this, even though Hillary's proposal allows them to keep a modestly preferential rate for investments held longer than two years and the current super-preferential rate for investments held for six years or more. Still, details aside, the rich account for virtually all the capital gains taxes paid, and raising that rate in any way would hurt them considerably. These are also the folks who are donating vast sums to the Republican candidates, so you can be sure they'll be insisting that their favored candidate goes after this proposal hammer and tongs. But Hillary is right. There's little evidence that higher capital gains rates do much harm, and a fair number of reasons to actively prefer a higher rate. Jared Bernstein has more here.

Here's How to Stop Covering Donald Trump: Stop Covering Donald Trump

| Fri Jul. 24, 2015 11:00 AM EDT

Message to everyone: You don't have to cover Donald Trump's every move. Honest. If you're going to whine and complain about how he's sucking all the oxygen out of the race, then stop covering him unless he does something genuinely newsworthy. Which actually isn't all that often.

For God's sake, how hard can this be? If clickbait is all that matters to you, fine. But don't pretend you're being journalists if that's all that's driving you.

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Hillary vs. the Press, Round One Million: The Times Screws Up a Scoop

| Fri Jul. 24, 2015 10:25 AM EDT

Hillary Clinton's email travails are a genuine problem for her. At best, relying solely on her own server to handle email while she was Secretary of State shows bad judgment, and at worst it might have violated government rules. There's not much question this is going to dog her going into next year's election.

That said, Jonathan Allen points out that the press is back to its old bad habits as well:

The Clinton rules are in full effect again. This case would fall under the umbrella of No. 3: The media assumes that Clinton is acting in bad faith until there's hard evidence otherwise. The New York Times, which got the scoop, rewrote its original story and is taking a beating from political observers and other media outlets for it. The first version said the inspectors general want a criminal investigation into Clinton's actions specifically, while the revised copy says they want the Justice Department to open a probe, more broadly, into whether the email was mishandled. It may turn out that Clinton is responsible for mishandling sensitive material, but the inspectors general didn't ask for an investigation into her, as the first version of the Times story said.

Here are the two versions of the Times lede:

Two inspectors general have asked the Justice Department to open a criminal investigation into whether Hillary Rodham Clinton mishandled sensitive government information....

 Two inspectors general have asked the Justice Department to open a criminal investigation into whether sensitive government information was mishandled....

The second one is correct. [See update below.] The request is a very generic one, asking whether the State Department misclassified some documents, and criticizing it for "its reliance on retired senior Foreign Service officers to decide if information should be classified, and for not consulting with the intelligence agencies about its determinations." Aside from the fact that the buck stops at the top, there's nothing here that's specifically about Clinton. And yet, the Times writers originally made their lede all about Hillary, almost as if on autopilot.

The feud between Hillary and the press is sort of like the Hatfields and McCoys: it's now so old, and so deeply ingrained, that it's almost impossible to tell who's more at fault. The press learned to deeply mistrust the Clintons during the 90s, sometimes with cause, and the Clintons learned to deeply mistrust the press at the same time, also sometimes with cause. The result is that Hillary does everything she can to shield herself from the press, and the press assumes that everything she does has some kind of sinister motive. Meanwhile, Republicans sit back and fan the flames, just as you'd expect them to.

It's gonna be a grim 2016 campaign if this keeps up.

UPDATE: Actually, even the second one is wrong. It's not a criminal investigation. From Politico: "In an attempt to clarify reports, a Justice Department official said on Friday, 'The Department has received a referral related to the potential compromise of classified information. It is not a criminal referral.' "

Uber vs. Taxis: Round 2 in the Big Apple

| Fri Jul. 24, 2015 9:15 AM EDT

On Monday I passed along some news about a study of cost and wait times for Uber vs. taxis in low-income neighborhoods in Los Angeles. In a nutshell, Uber was both cheaper and faster. Now, the same folks who did the LA study have done a quickie follow-up in the New York City boroughs of Brooklyn and Queens. It's based on a very small sample—so treat it with caution—but it found that although Uber was no cheaper than New York cabs, the wait time for a car was significantly less. Plus this:

Observations in which the taxi company refused to send a driver speak to the unreliability of dispatch taxi service in lower-income and geographically dispersed community districts of New York City. Of the total number of attempted dispatch taxi rides, the company was unable to send a driver within 30 minutes 38% of the time. Although it is possible these specific taxi companies did not serve the boroughs of Brooklyn or Queens except when dropping off or picking up a rider from the airport, this lack of clear information contributes to the difficulty riders new to the city generally or merely a particular part of the city face when attempting to travel around the city via car service.

The full report is here. As with the LA report, it was funded by Uber.

It's worth noting—though it should be obvious—that nothing in this report addresses various other concerns about Uber: pay and working conditions for drivers, regulatory compliance, privacy issues, etc. It's just data about one specific thing: how Uber compares to cabs on the metrics of price and convenience.

Surprise! EPA's New Power Plant Rules Aren't Going to Destroy America After All.

| Fri Jul. 24, 2015 12:13 AM EDT

Whenever a new environmental regulation gets proposed, there's one thing you can count on: the affected industry will start cranking out research showing that the cost of compliance is so astronomical that it will put them out of business. It happens every time. Then, when the new regs take effect anyway, guess what? It turns out they aren't really all that expensive after all. The country gets cleaner and the economy keeps humming along normally. Hard to believe, no?

Apologies for the spoiler, but can you guess what's happening now that President Obama's new carbon rules for power plants are about to take effect? Mitch "War on Coal" McConnell has been issuing hysterical warnings about these regulations for years, but the Washington Post reports that—sorry, did you say something? You've already guessed, have you?

More striking is what has happened since: Kentucky’s government and electric utilities have quietly positioned themselves to comply with the rule — something state officials expect to do with relatively little effort....“We can meet it,” Kentucky Energy and Environment Secretary Leonard Peters, speaking at a climate conference, said of the EPA’s mandate.

The story is the same across much of the country as the EPA prepares to roll out what is arguably the biggest and most controversial environmental regulation of the Obama presidency....Despite dire warnings and harsh political rhetoric, many states are already on track to meet their targets, even before the EPA formally announces them, interviews and independent studies show.

Iowa is expected to meet half of its carbon-reduction goal by next year, just with the wind-power projects already planned or in construction. Nevada is on track to meet 100 percent of its goal without additional effort, thanks to several huge ­solar-energy farms the state’s electricity utilities were already planning to build. From the Great Lakes to the Southwest, electric utilities were projecting huge drops in greenhouse-gas emissions as they switch from burning coal to natural gas — not because of politics or climate change, but because gas is now cheaper.

“It’s frankly the norm,” said Malcolm Woolf, a former Maryland state energy official and now senior vice president for Advanced Energy Economy....“We’ve yet to find a state that is going to have a real technical challenge meeting this.”

Try to contain your surprise.

It's Not Just Social Security Anymore. Jeb Bush Wants to Destroy Medicare Too.

| Thu Jul. 23, 2015 5:12 PM EDT

Republicans have been talking for years about "reforming" Social Security. Usually this involves privatizing it in some way, which they insist that people will love. In fact, they'll love it so much that, um, Republicans don't dare suggest that their reforms should apply to current recipients. Or to people who are within even a decade of retiring. Why exempt these folks? There's a lot of blah blah blah when you ask, but the real reason is that these people vote, and they actually pay attention to Social Security. They know perfectly well that the current system is a better deal for them. It's only younger workers, who don't pay as much attention and have been brainwashed—by conservatives—into believing that Social Security will never pay them a dime anyway, who give this nonsense the time of day. Even if the GOP's reformed version of Social Security is a lousy deal, anything is better than nothing. Right?

But I've never really heard this argument about Medicare. Until now. Here's Jeb Bush:

A lot of people recognize that we need to make sure we fulfill the commitment to people that have already received the benefits, that are receiving the benefits. But that we need to figure out a way to phase out this program for others and move to a new system that allows them to have something—because they’re not going to have anything.

Boom! If we don't gut Medicare, they'll have nothing. When they turn 65 they'll be out on the street dying, with no one to help them. Why? Because Democrats let the system go bankrupt. Wouldn't it be much better to offer them some crappy, rationed system instead? At least it's something, after all.

Jesus. You'd think we were Greece. Oh wait—these guys do think that Democrats are turning us into Greece. So I guess it makes a kind of sense.

In any case, Jeb sure picked the wrong time to make this pitch. Just yesterday we got the latest projections for Social Security and Medicare. If they're correct, the cost of both programs will top out at a combined 12 percent of GDP by the middle of the century and then flatten out. That's about 3 percent of GDP more than we're spending now.

So this is what Jeb is saying: Right now the federal government spends about 20 percent of GDP. We can't afford to increase that to 23 percent of GDP over the next 30 years. That would—what? I don't even know what the story is here. Turn us into Greece? Require us to tax millionaires so highly they all give up and go Galt? Deprive Wall Street of lots of pension income they can use to blow up the world again?

Beats me. This whole thing is ridiculous. Over the next 30 years, we need to increase spending by 1 percent of GDP per decade. That's it. That will keep Social Security and Medicare in good shape. Why is it so hard for people to get that?