Lunchtime Photo

My new camera has achieved the unthinkable: it's produced an image of Marian that she's allowed me to post on the blog. Using burst mode, I took 86 photos in about 60 seconds, which produced a grand total of two pictures she was happy with. I made the final choice, which is a little stagey, but still lovely. And check out that very nice bokeh in the background!

Ben Dreyfuss points me to something unexpected today. Christopher Ruddy is the CEO of NewsMax, which ranks right up with Drudge and Breitbart News in the ultra-right-wing website firmament. He's also a longtime pal of Donald Trump.

Hearing this, you probably figure that Ruddy opposes Obamacare, and you're right. But not quite for the reason you might think. Ruddy hates the private health insurance industry, which he calls a "racket," and his big problem with Obamacare isn't so much that it provides universal coverage, but that it does so by selling that coverage through private insurers. So Ruddy has an idea. He thinks Trump should ditch the Republican health care bill; pass a few minor tweaks that allow him to declare victory; and then pass his own plan:

  • Reject the phony private health insurance market as the panacea. Look to an upgraded Medicaid system to become the country's blanket insurer for the uninsured.
  • Tie Medicaid funding to states with the requirement each pass legislation to allow for a truly nationwide healthcare market.

In other words, Medicaid For All. It's not Medicare For All, but it's pretty interesting coming from a stone conservative.

Now, Ruddy also wants some other stuff. That "truly nationwide" health care market is, I assume, code for allowing insurers to sell across state lines.1 He also wants "modest" tort reform and expansion of HSAs.

But those are minor things that could be negotiated. The interesting thing here is Ruddy's belief that hatred of insurance companies is what really drives Trump supporters. Needless to say, plenty of liberals hate insurance companies too. I don't especially share this hatred, but private health insurance companies are inefficient, confusing, and administratively costly. I'd be happy to see them go away.

That makes this an interesting proposal. I doubt that liberals (or the medical industry) would support it unless Medicaid were bolstered in some way, but it certainly has the virtues of being (a) really simple and (b) truly universal if done right.2 I wonder if something like this has any chance of passage?3

1This is a conservative hobbyhorse that I continue not to understand. What's conservative about this, anyway?

2That is, free for anyone up to a fairly generous level, and with universal buy-in at reasonable cost for anyone else.

3It's worth pointing out that it does have one fatal flaw: it would cost a lot of money. That's the one thing conservatives are dead set against.

In a new study, three NBER researchers looked at the results of misconduct in the financial industry. Their conclusions were stark:

We document large and pervasive differences in the treatment of male and female advisers. Female financial advisers face more severe consequences at both the firm and industry level for engaging in misconduct relative to male advisers. While male advisers are more than two times as likely to engage in misconduct, female advisers are 20% more likely to be fired for engaging in misconduct. Female advisers are also 30% less likely to find new employment and face longer unemployment spells as a result of misconduct.

Firms may find it optimal to punish women more severely if female advisers engage in more costly misconduct or if female employees are less costly to replace. The empirical evidence suggests the exact opposite. Male advisers tend to engage in more costly misconduct and male advisers are twice as likely to be repeat offenders.

Here's a remarkable chart from their paper about how often financial advisors get fired and stay fired:

It's not just that women don't survive as long as men even though they appear to be equally productive. Women with no misconduct don't survive as long as men with misconduct on their record. And that's despite the fact that men engage in far more misconduct than women and are far more likely to be repeat offenders:

Finance is still a testosterone-fueled industry. Maybe it would be a safer one if we changed that.

Paul Ryan and President Trump have been insisting for months that Obamacare is collapsing, failing, imploding, spiraling quickly into death. This is ridiculous, of course. It's covering more than 20 million people at a lower cost than originally projected, and by any fair appraisal it's been hugely successful.

But that's not to say it has no problems. The Obamacare insurance pool is skewed toward the old and sick, and this has made it hard for insurers to turn a profit. Several smallish insurers have already left the market, and there are hundreds of counties in the US with only one insurer left on the exchanges. This is probably not fatal—CBO says the Obamacare market is stable—and it's a problem that could be addressed fairly easily and inexpensively. Still, it does put the Obamacare market in modestly perilous shape.

But what happens next? Even if the godawful Republican repeal effort fails, there's every reason to think that Congress will try again. What's more, it's clear that they'll do everything they can to undermine Obamacare along the way. In a few months, insurance companies have to decide whether they want to participate in the exchange market in 2018, and I wonder what they'll decide? The uncertainty is sky high now, and that means they have little incentive to continue. Remember, most insurers swallowed big losses early on in hopes of building a stable, profitable market later. But what's the point of absorbing losses if it looks like—at best—years and years of chaos ahead?

It may be that 2018 is safe. The exchanges are pretty close to profitable now, and it's probably worth it for most insurers to stay on board for at least another year to see what happens. Still, I wonder. Merely by upending everything and making it clear just how dedicated they are to cutting taxes on the rich and cutting health coverage for the poor, have Republicans already managed to effectively repeal Obamacare without passing a single page of legislation?

Hear me out. Today Breitbart News published an audio recording of Paul Ryan disowning Donald Trump during the campaign:

In the Oct. 10, 2016 call, from right after the Access Hollywood tape of Trump was leaked in the weeks leading up to the election, Ryan does not specify that he will never defend Trump on just the Access Hollywood tape—he says clearly he is done with Trump altogether.

"I am not going to defend Donald Trump—not now, not in the future," Ryan says in the audio, obtained by Breitbart News and published here for the first time ever.

This isn't really big news. We pretty much knew this was what Ryan said back when he said it. But apparently Breitbart has been holding onto this recording until the time came when they could get the maximum mileage from giving Ryan's remarks another news cycle. That turned out to be today, right after the Congressional Budget Office had released a devastating report on Ryan's health care bill.

Then, a few hours later, someone in the White House leaked an internal analysis that says Ryan's bill is even worse than the CBO says it is—quite a feat, given that the CBO trashed the bill pretty comprehensively.

We know that Breitbart and Steve Bannon have long loathed Paul Ryan. So…maybe this was all orchestrated by Bannon? Wait for the CBO wrecking crew to come through, and then release both an embarrassing audiotape of Ryan and an embarrassing White House analysis that confirms just how bad Ryan's bill is.

Was Trump in on this—waiting until just the right moment to take his revenge on Ryan for insufficient loyalty during the campaign? Or is this Bannon acting on his own? Or just a coincidence? I'm not sure. But one way or another, it sure seems like a coordinated effort to doom Ryan's bill and wreck his reputation with his own caucus.

My brain is imploding. HHS Secretary Tom Price said today that CBO's estimate of insurance losses under the Republican health care bill "defy logic." But it turns out the White House—which Price works for—agrees with the CBO. In fact, they think CBO is a little too optimistic. Here is Politico:

The White House's own internal analysis of the GOP plan to repeal and replace Obamacare show even steeper coverage losses than the projections by the Congressional Budget Office, according to a document viewed by Politico on Monday.

The executive branch analysis forecast that 26 million people would lose coverage over the next decade, versus the 24 million CBO estimate — a finding that undermines White House efforts to discredit the forecasts from the nonpartisan CBO.

But...no...that's completely...it doesn't make...it's...it's...it's...I mean...WHAT THE FUCKITY FUCKING FUCK-ALL FUCK IS GOING ON HERE?

Sorry about that. But I'm afraid this is about the most incisive analysis I have to offer. The Republican health care effort is a fiasco beyond even my wildest imagination.

Back in the past, about 17 percent of Americans went without health insurance. In the future, according to the CBO, about 17 percent of Americans will go without health insurance if AHCA, the Republican health care bill, passes. In between is the short, happy valley of Obamacare, when we got that number down to about 10 percent:

The CDC has precise numbers for the present if you're interested. The Obamacare smile in the chart above is just approximate. Bottom line: if AHCA passes, not only will all the good work of Obamacare be wiped out, but uninsurance rates will actually be higher than they used to be when we had no legislation at all. I'm not quite sure how Republicans managed to pull that off, but it's an impressive feat of callousness and greed.

Are you interested in additional detail about exactly which groups will be less insured under AHCA? The answer is: all of them. Here's the absolutely appalling CBO estimate:

Poor people will have less insurance. Working-class people will have less insurance. Middle-class people will have less insurance. The young will have less insurance. The middle-aged will have less insurance. The old will have less insurance. Everybody will have less insurance. Except for the rich, of course, who will also get an $882 billion tax cut.1

This is what Paul Ryan calls "encouraging." I'm not sure how he looks at himself in the mirror every morning.

1In fairness, they have to share this tax cut with big corporations.

What do people think about the new CBO report on RepubliCare? I don't mean us bleeding heart liberals. Naturally we think it's great since it confirms that the Republican bill will decimate health care in America. But what do conservatives think?

HHS Secretary Tom Price says the CBO report is ridiculous. It "defies logic," he says:

But over on Capitol Hill, Paul Ryan says he finds the CBO's report "encouraging." It exceeded his expectations and "gives us even more room to work on good, fine-tuning finishing touches." Hoo boy. Even Fox News isn't buying this:

This is some serious happy talk. Ryan must be taking lessons from Trump. In a statement, Ryan says the report confirms that the Republican bill will "lower premiums and improve access to quality, affordable care"—which is, um, a pretty creative reading of the report. More to the point, Ryan is thrilled that the CBO confirms that the bill will provide "massive tax relief." This is true—though the tax relief is all for the rich—and it's telling that Ryan doesn't need to provide any spin on this point.

But what about all those people who will lose coverage? Ryan says, "I recognize and appreciate concerns about making sure people have access to coverage." He doesn't say he plans to do anything about this, but at least he appreciates the concerns. You know who else appreciates those concerns? Breitbart News:

The Drudge Report is pretty much ignoring the whole thing for the moment, as if they're waiting for some kind of conservative consensus to form before they wade in. National Review is pretty silent too, though Dan McLaughlin writes that "The projections of who will and won’t be insured don’t actually mean anything." The Weekly Standard's Chris Deaton has a carefully neutral post up that says millions of Americans "would opt out of purchasing coverage once the federal government stops penalizing them for doing so." That's not quite what CBO says, though I admit you have to read the report carefully to recognize this.1

Basically, no one outside of Congress or the White House really wants to defend the Republican bill. There are a few half-hearted gibes at the CBO, but nothing more. I'll be curious to see if tribal defenses kick in more strongly by tomorrow, once everyone has had a chance to suffer through all the liberal jeers and taunts.

1CBO says that subsidies after 2020 would be "significantly smaller" than they are now and that "some people would forgo insurance in response to higher premiums." However, they are oddly cagey about exactly how big an effect this would have compared to the elimination of the individual and corporate mandates. I'm not sure what the reason for this is.

While I was out to lunch, I was feeling bummed that I wouldn't immediately see the CBO score of the Republican health care bill. As Hyman Roth said, "This is the business we've chosen." Still, that's kind of pathetic, isn't it?

But I've seen it now (click here), and the headline news is CBO's projection of how many more people will become uninsured compared to Obamacare: 14 million in 2018, 21 million in 2020, and 24 million in 2026. But here's the thing. The last time I saw a CBO estimate, it projected that Obamacare would reduce the ranks of the uninsured by 27 million people in 2025, and today's report projects 28 million in 2026. So here's what the Republican plan looks like:

You read that right: CBO projects a decline of 24 million from a baseline of 28 million. Of the 28 million people currently insured because of Obamacare, only 4 million will be left by 2026.

With a couple of corrections because I mistakenly used an old CBO report, this matches almost perfectly my estimate from last week of the impact of RepubliCare. Not bad! Unfortunately, the price of my being right is that 24 million people will be uninsured yet again if Republicans manage to pass their monstrosity of a bill. Here are CBO's other three main findings:

  • The Republican bill would reduce the deficit by $337 billion over ten years, mainly by kicking lots of people off Medicaid
  • Premiums would go up until 2020, and then decrease. By 2026 they'd be about 10 percent lower than now.
  • The individual market would remain stable.

I'm a little surprised by the last bullet. According to the report, "key factors bringing about market stability include subsidies to purchase insurance, which would maintain sufficient demand for insurance by people with low health care expenditures, and grants to states from the Patient and State Stability Fund which would reduce the costs to insurers of people with high health care expenditures."

Unless I'm missing something, CBO is projecting "sufficient demand" at the same time they're saying that demand will crater. As for the stability fund, that comes to $10 billion per year, maybe half of which is actually for high-risk patients. That's practically a rounding error in the health care market. Something doesn't smell right here.

That said, the big news is the projection of 24 million people losing health coverage by 2026. I wondered last week if CBO would have the guts to make a projection like this, and it turns out they did. Republicans may try to keep up the pretense that their bill would continue to insure practically everyone, but the truth is just the opposite: almost no one would be covered. And that's a feature, not a bug.

UPDATE: I've changed the headline and the text from 3 million to 4 million. The CBO report I linked above projected that Obamacare would be responsible for a net increase of 27 million insured people by 2025, so I initially used that number for 2026 as well. That left 3 million still insured after a decline of 24 million. But today's CBO score says the 2026 number is 28 million under Obamacare. So 4 million would be left under the Republican bill.

I just want to say that I'm very excited by the CBO's score of the Republican health care bill. I'll explain when I get home from lunch. In the meantime, the nutshell version is pretty simple: this bill is really, really bad.