Kevin Drum

Premium Increases Under Obamacare Have Stayed Really Low

| Wed Apr. 13, 2016 8:27 PM EDT

The Department of Health and Human Services has issued a report on 2016 premium increases under Obamacare. This is useful information if you want to answer the following question:

How much do actual Obamacare users have to pay for coverage?

Of course, if this is the question you're interested in then you have to take into account all the data. You can't cherry pick just one or two providers; you can't focus on just the states with the highest increases; you can't ignore the fact that lots of people shop around for the best price each year; and you can't pretend the federal subsidies don't exist. You have to take a look at the nationwide average of what users actually paid. When you do, it turns out that premiums increased about 4 percent this year in the federal marketplace.

But that's not the only question you might want to ask. There's also this one:

How has Obamacare affected the cost of health coverage more generally?

You can't answer this by looking only at Obamacare because there's nothing to compare it to. You can't compare Obamacare premiums to premiums in the individual market prior to 2013, because the individual market excluded sick people. Naturally premiums used to be lower. Nor can you compare Obamacare premiums to premiums for employer health care. The coverage is completely different. It's apples to oranges.

But there are other things you can look at. For example, you can look at the cost of employer coverage over the past decade or so. If Obamacare has devastated the insurance market or jacked up the cost of health care, it will show up here. And this is a nice, clean series for the entire period that provides an apples-to-apples comparison. You can see it on the right.

Long story short, nothing much has happened. The annual increase in premiums declined to about 5 percent in the mid-aughts, and since Obamacare passed it's been about 3 percent. Nothing to see here.

Now, we only have two years of data since Obamacare passed, so this is still pretty tentative. And you might also be interested in how coverage has changed and what kind of out-of-pocket costs workers are bearing these days. Those are all worthwhile things to look at depending on what questions you're asking.

But if you want to know about the cost of health care coverage, the answer is pretty simple. Since Obamacare has gone into effect, its users have seen modest premium increases. This year it's around 4 percent in the federal marketplace. And employer premiums have stayed steady too. Over the past couple of years, they've increased about 3 percent annually.

Maybe this will change as time goes by. But for now, Obamacare doesn't look like it's done any damage at all to the price of health insurance. In fact, it might have helped. That's what you see if you take a fair look at all the data.

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Health Update

| Wed Apr. 13, 2016 3:39 PM EDT

More good news this month: My M-protein level has declined again, from 0.43 in March to 0.37 in April. Overall, it's gone down by about a third since the start of the year, so apparently the dex is doing some good. And speaking of dex, with the dosage reduced from 20 mg to 12 mg, I'm no longer staying up all night on Friday and I'm sleeping better the rest of the week. A few other annoying side effects are still hanging around, but nothing too bad. Hooray!

Hillary Clinton Wants to Eliminate Lead Within Five Years

| Wed Apr. 13, 2016 3:05 PM EDT

In a speech on environmental justice today, Hillary Clinton made a bold proposal:

Be still my heart! Hillary's plan has eight parts, and the first one is all about lead poisoning:

Eliminate lead as a major public health threat within five years....For every dollar invested in preventing childhood exposure to lead, between $17 and $200 is saved in reduced educational, health, and criminal justice expenses and improved health and economic outcomes—but the few federal programs that exist are inadequate to address the scope of the problem and have seen significant budget cuts and volatility in recent years.

....Eliminating lead as a major public health threat to our children is a goal we can and must meet as a nation. Clinton will establish a Presidential Commission on Childhood Lead Exposure and charge it with writing a national plan to eliminate the risk of lead exposure from paint, pipes, and soil within five years; align state, local and philanthropic resources with federal initiatives; implement best prevention practices based on current science; and leverage new financial resources such as lead safe tax credits. Clinton will direct every federal agency to adopt the Commission’s recommendations, make sure our public water systems are following appropriate lead safety guidelines, and leverage federal, state, local, and philanthropic resources, including up to $5 billion in federal dollars, to replace lead paint, windows, and doors in homes, schools, and child care centers and remediate lead-contaminated soil.

I don't think five years is anywhere near feasible—it's more like a 10-20 year project—but that's a nit. I'm especially happy to see Hillary acknowledge the importance of remediating lead in soil, which usually doesn't get much attention. But that's where all the lead from automobile emissions settled, and it's worst in low-income urban neighborhoods that are dense with traffic.

Unfortunately, it's also the most difficult to address. Replacing lead water pipes is expensive, but we know how to do it. Getting rid of lead paint in old houses is a little less expensive, especially if we concentrate on doors and window sills, but we know how to do that too. That leaves lead in soil, which is tough because there's so damn much of it. The first step is to map the highest concentrations of lead in soil around the country, and we haven't even done that yet. Next we have to figure out the best way to get rid of it. There are lots of different methods, and they differ a lot in cost. You can, for example, simply haul away the top few inches of soil. That's expensive. Alternatively, there's a lot of buzz around the idea of seeding contaminated soil with phosphates, which combine with lead to produce harmless pyromorphite. This can be done using fish bones, which contain calcium phosphates. And fish bones are cheap.

But does this really work? It looks like a promising approach, but it still needs more research. Either way, though, it's nice to see a presidential candidate take lead seriously. We've been making progress on lead contamination for decades, but we've never truly made it a consistent priority. It's time to do that.

The Wall Street Journal Cons Its Readers Yet Again

| Wed Apr. 13, 2016 1:08 PM EDT

Every once in a while I get suckered into reading a Wall Street Journal op-ed. I'm not sure why. They're all the same, after all. Today the clickbait (or is it hatebait?) was "History of a Climate Con" from Holman Jenkins:

A little history is in order to appreciate the cynical nadir of climate politics in the U.S. You wouldn’t know it from media coverage, but the closest the U.S. Congress came to passing a serious (if still ineffectual) cap-and-trade program was during the George W. Bush administration in early 2007. Then, within days of Barack Obama’s election in 2008, Al Gore announced a revelation: the “climate crisis” no longer required such unpleasant, de facto energy taxes. The problem could be solved with painless handouts to green entrepreneurs.

Hooray! Everybody loves a handout. The activist duo Michael Shellenberger and Ted Nordhaus noted that the shift in Mr. Gore’s thinking was “highly significant.” “He knows that cap-and-trade, and most any new regulation, would raise energy prices—a political nonstarter during a recession.”

A proposed oil tax swiftly disappeared from the Obama transition website. With control of all three branches of government in hand, the imminent climate threat to humanity suddenly appeared not so urgent after all—passing a “signature” health-care law did. Democrats, it turned out, were in favor of climate root canal only when Republicans were in charge.

George Bush! Who knew he was such a climate change advocate?

He wasn't, of course. The 2007 bill was introduced by Joe Lieberman and opposed by George Bush. It eventually failed to overcome a Republican filibuster and went down 48-36. There were a grand total of 7 Republicans who voted to proceed and 4 Democrats against. In other words, it failed because nearly the entire Republican Party opposed it and a handful of Democrats joined them.

Fast forward to 2010. A cap-and-trade bill supported by President Obama passes the House with strong Democratic support and nearly unanimous Republican opposition. This is the most serious cap-and-trade effort of the past decade. But in the Senate, after considerable debate, Harry Reid eventually pulls the plug because he can't find 60 votes to overcome a Republican filibuster. As in 2007, a cap-and-trade bill fails because nearly the entire Republican Party opposes it and a handful of Democrats join them. Neither the urgency of climate change nor Democratic control of the Senate had anything to do with it.

Nor did Al Gore change his mind on anything after the 2008 election. In the context of a massive recession and the promise of a stimulus bill from the Obama administration, it's true that he favored spending lots of money on incentives to fund clean energy initiatives. Why wouldn't he? However, in the same breath he maintained that "the United States should lead the way by putting a price on carbon here at home, and by leading the world’s efforts to replace the Kyoto treaty next year in Copenhagen with a more effective treaty."

I continually wonder why Wall Street Journal readers enjoy paying good money to get lied to so routinely. There's almost literally nothing true about that passage above. And yet, apparently this is what the Journal's audience craves. Why?

Here's How to Apologize to a Smart 20-Year-Old

| Wed Apr. 13, 2016 11:48 AM EDT

According to a bit of research from the Ohio State University, the best apologies contain two elements:

  • Acknowledgment of responsibility
  • Offer of repair

That's it. It's also nice—but not really necessary—to express regret, explain how you screwed up, and say you're sorry. Asking for forgiveness can be tossed in the ash can. Nobody cares.

This is good to know. However, it's also good to know that this is your typical SocSci study, conducted with some folks online and then repeated with a bunch of undergrads. So this is basically a study of what kind of apology your typical high-IQ 20-year-old appreciates most. Whether this says anything about the rest of us I couldn't say.

Feeling Hungry? Have a Deep-Fried Butter Ball.

| Wed Apr. 13, 2016 11:09 AM EDT

Nutritional research is really hard. To do it right, you need a large sample of people; you need to randomly assign them to different diets; they need to actually stick to the diet; and they have to be followed for years. In real life, this is almost impossible.

However, back in the 60s we had different ideas about how we were allowed to treat mental patients, and that led to a large-scale study of cholesterol and saturated fat at a mental institution in Minnesota. Whatever you think of the ethics of an experiment like this, it's pretty much ideal from a research point of view. The patients can be fed whatever you want; they have no choice but to stick with the diet; and physically they're fairly typical. So the study got done, and the researchers concluded that a low-fat diet was a good thing.

But it turns out the researchers were pretty dedicated to finding that result in the first place. Recently, the full results of their study were unearthed and analyzed, and it turns out their conclusions were wrong. Totally wrong:

The fuller accounting of the data indicates that the advice is, at best, unsupported by the massive trial. In fact, it appears to show just the opposite: Patients who lowered their cholesterol, presumably because of the special diet, actually suffered more heart-related deaths than those who did not.

The higher rate of mortality for patients on the special diet was most apparent among patients older than 64....“Had this research been published 40 years ago, it might have changed the trajectory of diet-heart research and recommendations” said Daisy Zamora, a researcher at UNC and a lead author of the study.

....“What this research implies is that there is not enough evidence to draw strong conclusions about the health effects of vegetable oils” Christopher Ramsden, a medical investigator at NIH and a lead author of the study, said in an interview.

Ramsden and colleagues discovered the missing data during their research examining the potentially harmful effects of linoleic acid — a key constituent of most vegetable oils — on human health.

Their paper notes that before the advent of agriculture, humans got 2 to 3 percent of their calories from linoleic acid; today most Americans, awash in cooking oils and oils added to snack foods, get much more. Preliminary research suggests a link between linoleic acid and diseases such as chronic pain, Ramsden said.

I've mentioned before that I'm semi-convinced that nutritional advice for the past half century has been wildly off base. It's quite possible that the rise in obesity and other health problems in America is due not to saturated fats, but to our enormous intake of vegetable oil. That, after all, is what's new in American diets since 1900. Before then, we barely used vegetable oil at all and we were pretty healthy. Now we use it by the tanker car and we're in pretty sad shape.

To know for sure, we need two things. First, researchers with an open mind. Second, reliable nutritional studies. Unfortunately, since forcing mental patients to be saturated-fat guinea pigs is no longer on the table, it's as hard as ever to conduct reliable studies. Still, keep in mind that the weakness of nutritional studies works both ways: all the evidence that saturated fats are bad and vegetable oil is good is pretty thin too. Go ahead and smear some butter on that toast.

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The Gender Pay Gap Is Still About 21 Cents Per Dollar

| Tue Apr. 12, 2016 3:59 PM EDT

Today is Equal Pay Day, so let's break down the numbers for the gender pay gap. According to an up-to-date study by Francine Blau and Lawrence Kahn, the current wage gap for annual earnings is 21 cents: On average, women earn 79 cents for every dollar a man earns.

So that's the headline number. But what are the causes of the gap in men's and women's earnings? Blau and Kahn break it down into seven buckets:

You can look at this two ways. The first is to say that the pay gap due to discrimination (the most likely cause of the "unexplained" part of the chart above) is about 10 cents per dollar, since roughly 11 cents is explained by other factors, such as experience in the job, occupation, industry, etc.

The second way—which is my take—is that it's true that some of the gap goes away when you account for the fact that women tend to work in different jobs than men and take more time off to have children. But that's all part of the story. When you look at the whole picture, women are punished financially in three different ways: because "women's jobs" have historically paid less than jobs dominated by men; because women are expected to take time off when they have children, which reduces their seniority; and because even when they're in the same job with the same amount of experience, they get paid less than men. All of these things are part of the pay gap. Whether you call all three of them "discrimination" is more a matter of taste than anything else.

But however you choose to approach it, the gender pay gap still exists. It's at least 10 cents per dollar, and more like 21 cents if you accept that most of the mitigating factors are gender-based as well.

Paul Ryan Does Not Want to Be Your Next President

| Tue Apr. 12, 2016 2:07 PM EDT

Paul Ryan will apparently be making a Shermanesque statement about an hour from now:

Ryan...has arranged a hastily called 3:15 p.m. press conference inside the Republican National Committee. Advisers say he will insist — in his clearest terms yet — to the GOP’s big donor and lobbyist class that he will not attempt to claim the nomination at the July convention in Cleveland.

“He’s going to rule himself out and put this to rest once and for all,” a Ryan aide said, requesting anonymity to discuss the planned speech.

Stay tuned. Presumably this is good news for Ted Cruz.

UPDATE: And the press conference is now over:

“Let me be clear,” Mr. Ryan said. “I do not want nor will I accept the nomination of our party.” He added that he had a message for convention delegates: “If no candidate has the majority on the first ballot, I believe you should only turn to a person who has participated in the primary. Count me out.”

That seems suitably blunt.

Weekly Flint Water Report: April 2-7

| Tue Apr. 12, 2016 2:00 PM EDT

I got tired of waiting for Michigan's DEQ to post Friday's water testing result, so here is this week's Flint water report through Thursday. As usual, I've eliminated outlier readings above 2,000 parts per billion, since there are very few of them and they can affect the averages in misleading ways. During the week, DEQ took 368 samples. The average for the past week was 10.07.

Can You Guess Who Gets the Most Abuse in Comments?

| Tue Apr. 12, 2016 12:52 PM EDT

The Guardian decided to analyze their corpus of 70 million comments to see who gets the most abuse. The results won't surprise you:

Although the majority of our regular opinion writers are white men, we found that those who experienced the highest levels of abuse and dismissive trolling were not. The 10 regular writers who got the most abuse were eight women (four white and four non-white) and two black men…And the 10 regular writers who got the least abuse? All men.

Of course, certain subjects invited more abuse than others:

And abuse that starts in one place can spread astonishingly quickly via social media:

Avalanches happen easily online. Anonymity disinhibits people, making some of them more likely to be abusive. Mobs can form quickly: once one abusive comment is posted, others will often pile in, competing to see who can be the most cruel. This abuse can move across platforms at great speed—from Twitter, to Facebook, to blogposts—and it can be viewed on multiple devices—the desktop at work, the mobile phone at home. To the person targeted, it can feel like the perpetrator is everywhere: at home, in the office, on the bus, in the street…This must surely have a chilling effect, silencing people who might otherwise contribute to public debates—particularly women, LGBT people and people from racial or religious minorities, who see others like themselves being racially and sexually abused.

Is that the kind of culture we want to live in?

Is that the web we want?

The article also includes a short quiz: Which comments would you ban? I disagreed with two out of eight of their real-life examples.