Over at The Upshot, Margot Sanger-Katz catches something that any of us might have noticed if we'd had keen enough eyes. The CBO famously projected that the Republican health care bill would result in 24 million people losing health insurance:

But one piece of context has gone little noticed: The Republican bill would actually result in more people being uninsured than if Obamacare were simply repealed. Getting rid of the major coverage provisions and regulations of Obamacare would cost 23 million Americans their health insurance, according to another recent C.B.O. report. In other words, 1 million more Americans would have health insurance with a clean repeal than with the Republican replacement plan, according to C.B.O. estimates.

Here's what the CBO said in its January report. If only the individual mandate, the subsidies, and the Medicaid expansion are repealed, 32 million people will lose insurance by 2026. If, in addition, community rating, minimum coverage requirements, and the preexisting conditions ban are repealed—in other words, if essentially all of Obamacare is repealed and nothing put in its place—23 million people will lose insurance by 2026.

As it happens, the current Republican bill is similar to Option 1, which means the GOP is making progress. Under their old bill 32 million people would be kicked off the insurance rolls, while the new bill only kicks off 24 million. However, they could do even better by just repealing everything, full stop.

Their problem, of course, is that they can't do that. Democrats can filibuster all the additional stuff in Option 2. Nevertheless, Sanger-Katz is right: it's pretty remarkable that the Republican bill actually does more damage than repealing Obamacare and simply doing nothing at all. Not just any political party can pull off something like that.

Lunchtime Photo

This little girl looks...worried? Dismayed? Unsure? Maybe all those things. She had just been playing with her little sister and sort of "helped" her into a nearby fountain. Dad was nearby and didn't seem especially concerned about the whole thing, but she doesn't know that yet as she surveys the damage. She is not yet sure what the future holds for her.

CBPP has calculated how much tax money you'll save if Obamacare is repealed. Behold:

You know what really gets me? Even among the millionaires, repeal will only net them about $50,000. That's like finding spare change in the sofa cushions for this crowd. Is clawing back a few nickels and dimes really worth immiserating 20 million people?

Bruce Bartlett points me to a C-SPAN survey that, among other things, asks people if they can name any Supreme Court justices. Here are the results:

That thin orange line that's zero across the entire bottom of the chart is the number of people who named Stephen Breyer. Poor guy. However, it's still possible that he was the first choice of at least a few people. The survey size was 1,032 people, so anything less than five would get rounded down to zero. Breyer might very well have been named by three or four people.

Anyway, the two big takeaways are (a) the older you are, the more likely you are to know at least one justice, and (b) Ruth Bader Ginsburg kicks ass. Even the chief justice isn't better known than her. Good job, RBG.

Of course, they'd all have better Q scores if they followed the advice of 76 percent of the public and allowed arguments to be televised.

I am doing something that really annoys some people: posting occasional videos that always seem to end up on YouTube's trending list. Check out yesterday's barroom brawl over a female duck:

I'm ahead of the Kardashians! And with a mere 888 views, compared to their 311,000. And I'm only slightly behind the giant pizza cone, which has over a million views.

Just out of curiosity, does anyone know why this happens? I gather that a lot of people work very hard for a spot on this coveted list, whereas I just upload run-of-the-mill cat and duck videos and do nothing to promote them. Do I get extra credit for all the folks who watch the video on the blog? Or does YouTube just have very discerning taste?

Donald Trump's tweets are, at various times, ridiculous, offensive, and obviously untrue. Sometimes all three. David French doesn't like what this is doing to conservatives:

The tweets, however, are exposing something else in many of Trump’s friends and supporters — an extremely high tolerance for dishonesty and an oft-enthusiastic willingness to defend sheer nonsense....I’ve watched Christian friends laugh hysterically at Trump’s tweets, positively delighted that they cause fits of rage on the other side. I’ve watched them excuse falsehoods from reflexively-defensive White House aides, claiming “it’s just their job” to defend the president. Since when is it any person’s job to help their boss spew falsehoods into the public domain?

....GOP gratitude for beating Hillary Clinton cannot and must not extend into acceptance (or even endorsement) of presidential dishonesty and impulsiveness. Trump isn’t just doing damage to himself. As he lures a movement into excusing his falsehoods, he does damage to the very culture and morality of his base. The truth still matters, even when fighting Democrats you despise.

I'm not sure Trump really had to work very hard to bring out these traits among conservatives. Drudge and Limbaugh and Fox News and now Breitbart have been mining this same vein for decades. But we can leave that argument for another time.

None of us has a lock on truth, but we should at least try to value the truth as best we can discern it. I would be very happy to see liberals and conservatives alike make at least some modest movements toward that goal. But I'm not holding my breath.

The Wall Street Journal reports that although US stocks are doing well, world stocks are doing even better:

Several major stock indexes that exclude U.S. stocks are on pace to best the S&P 500 for the first time since 2012, according to Morningstar. It’s a trend that’s playing out in both developed and emerging markets....The Vanguard Total World Stock Index Fund, which owns global stocks, including the U.S., is up 7.5% and is so far on pace to top the S&P 500 by the widest margin since 2009.

Sure enough, the S&P 500 (in blue) is doing worse than three different Vanguard ETFs that track non-US stocks:

A word of warning, though: I had to cherry pick the starting date pretty carefully to get this view. Starting dates that differ by even a few days produce a much tighter cluster. And most of the S&P's performance woes are due solely to a lackluster March.

Still, the Vanguard All-World ETF (in green) has been consistently better all along by a fair margin over the S&P 500. Generally speaking, it's fair to say there's nothing special about the American stock market surge over the past few months. It's just riding along with the rest of the world.

Republicans like to say they want to "reform" Medicaid because it's so terrible for poor people. "More and more doctors just don’t take Medicaid," Paul Ryan claimed when he unveiled his health care bill. Jordan Weissmann isn't buying it:

It is true that many doctors do not accept new Medicaid patients, in large part because the program pays physicians relatively little for their services. But new data suggests Ryan is dead wrong when he says this is a growing problem. If anything, it appears that more doctors have started to see Medicaid enrollees in the years since the program expanded under the Affordable Care Act....According to the doctor job placement company Merritt Hawkins, 53 percent of physicians in 15 large cities said they were accepting Medicaid patients in 2017. That's up from 45.7 percent in 2014, when the Medicaid expansion began, and down slightly from 2009, when it was 55 percent.

This is all true, but it's worth taking a look at the whole picture. Here's the Merritt Hawkins data since 2004 for Medicaid and since 2014 for Medicare:

Among specialties, the number of doctors taking new Medicaid patients has stayed about the same since 2004. However, in family medicine, it's gone down by about ten points. And in both cases, the numbers hover around 55 percent, far lower than Medicare's 80 percent.

It's also worth taking a look at the enormous differences from city to city:

This chart is for big cities. Average acceptance rates are slightly higher in mid-size cities, and the distribution between cities is a little narrower. Overall, Medicaid is a little better off in mid-size cities and towns than it is in big urban areas.

Generally speaking, Weissmann is right that doctor acceptance of Medicaid doesn't appear to be a worsening problem. He's also right about Republican crocodile tears: if they want to improve acceptance rates, they need to pay doctors more, not cut funding for Medicaid under the guise of reform. And he's right that Medicaid isn't too different from cheap private plans that significantly restrict doctor choice.

At the same time, Medicaid definitely has its problems. Only about half of doctors accept it, and what's worse, this varies dramatically between cities. If you live in Minneapolis or Philadelphia, you're probably OK. But if you live in New York or anywhere in the South, good luck finding a doctor who's nearby and doesn't have huge wait times.

We accept this as a nation because, hey, it's just welfare for poor people and they should be grateful for what we give them. And for the most part, they are: people on Medicaid generally give it good marks because it's simple, free, and way better than not having any coverage at all. But the way we treat it is still pretty shameful. The day can't come soon enough when Medicaid, Medicare, and private coverage are finally all merged into a single national system and everyone is guaranteed decent care.

Apparently the House leadership is going to introduce an amendment to its health care bill tonight. According to Politico, here are its major provisions:

  • Adds $75 billion to reduce premiums for old people. But in an awesome display of legislative farce, the amendment doesn't actually set up the tax credits. It just tells the Senate to do it. So House Republicans have to vote for a pig in a poke.
  • Repeals Obamacare taxes a year earlier.
  • Increases Medicaid reimbursements for the elderly and disabled.
  • Deletes a provision that allows people to transfer unused tax credits into a Health Savings Account. Apparently some activists were afraid this might indirectly allow tax credits to be used for abortions.
  • Allows states to establish work requirements for Medicaid.
  • Allows states to take Medicaid as a block grant, presumably so they have more flexibility to use Medicaid money any way they want and more authority to tighten requirements for the poor.

In summary, we have:

  • Two provisions that help the old.
  • Two provisions that screw the poor.
  • Three provisions that increase the deficit.
  • And one provision that somehow caught the attention of anti-abortion paranoids.

If that isn't a Republican amendment, I don't know what is. Sadly, it also spends more money, which is enough for many members of the tea-party wing to oppose it. So we're back to Paul Ryan's usual conundrum: Half of Republicans are worried about his bill being disastrously stingy, and want to spend more money to guarantee higher benefits. The other half are worried that the bill continues to spend any money at all, and want to cut its already meager benefits further in order to reduce spending even more.

How do you reconcile this? By telling everyone, "This is your one chance to repeal Obamacare." I guess that might do it, though it's hard to say for sure. The vote is coming on Thursday, and plenty of people think Ryan doesn't have the numbers to pass it. We'll see.

Neil Gorsuch is unlikely to give away anything concrete in his confirmation hearings for the Supreme Court, so Ramesh Ponnuru has a list of philosophical concerns for him to address. Here's question #1:

The Supreme Court in its early decades rarely set aside federal laws. It first did so in 1803, and went another 54 years before doing it again. So at least one of the following three things would seem to be true. Either the federal government now enacts a lot more unconstitutional laws; or the justices gained a better understanding of their jobs as the Founding receded into history; or the Court has seized more and more power from the other branches. Which explanation makes the most sense?

I assume that the "correct" answer is the third one, though Ponnuru doesn't give away his own opinion. But this is a very salient question. In 2012, conservatives urged the Supreme Court to set aside Obamacare even though:

  • Everybody agreed that health care was a large and indispensable part of interstate commerce. Everybody also agreed that the Constitution grants supreme and extremely broad authority over interstate commerce to the federal government.
  • Obamacare was unquestionably the kind of political issue that's assigned to Congress and the executive by the Constitution.
  • It was passed properly and signed into law after lengthy deliberation and careful consideration.
  • A string of precedent more than 60 years old suggested Obamacare's provisions were well within Congress's commerce and taxing powers.
  • It required people to take certain actions and it levied a penalty for not not following the law, something Congress has done many times before without incident.

The counterargument was literally invented out of whole cloth for the sole purpose of being applied to Obamacare: namely that Congress can penalize actions, but not inactions. Antonin Scalia made this famous as the "broccoli test." In two centuries, no one had argued this before. The Supreme Court had never breathed so much as a word about this distinction.

But conservatives were eager for the Supreme Court to take this hairsplitting argument and apply it not to a small and modest law as a future warning for lawmakers, but to perhaps the most consequential law enacted in the past half century. No member of Congress could possibly have imagined that this distinction between action and inaction would matter, since liberals and conservatives alike had proposed health care mandates before and no one had suggested it might be a problem.

So I agree with Ponnuru. I would very much like to hear what Gorsuch thinks about how freely the Supreme Court should set aside federal law. Should bigger laws require bigger reasons? Should it matter whether the Supreme Court has provided any guidance before? Should it matter how new and creative the argument is for overturning a law? Should Congress be given more deference in some areas than others? Which ones? Should it matter how big the consequence is of violating a law? These all sound like very interesting questions to me.