Kevin Drum

Chart of the Day: Healthcare Industry Approves of Obamacare Decision

| Thu Jun. 25, 2015 9:14 PM EDT

They might not have said so very loudly, but the health care industry really didn't want to see Obamacare gutted by the Supreme Court. They've invested a lot of money into adapting to it, and to them it's not socialism run amok or looming tyranny. It's a positive development that's bringing American health care into the 21st century. As you can see in the chart below, Wall Street reflected this. When the Supreme Court's decision was announced, everyone breathed a sigh of relief and health care stocks soared.

Obamacare: Good for America, good for business.

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President Obama Has Had a Pretty Good Week

| Thu Jun. 25, 2015 3:05 PM EDT

So....pretty good week for Obama, eh? He got fast-track passed; he won the Obamacare case in the Supreme Court; and Confederate flags are coming down all over America.

Not bad for a "very lame, lame duck."

John Roberts Now Officially the Fourth Conservative Sellout on the Supreme Court

| Thu Jun. 25, 2015 2:42 PM EDT

From Quin Hillyer at National Review:

With today’s Obamacare decision, John Roberts confirms that he has completely jettisoned all pretense of textualism. He is a results-oriented judge, period, ruling on big cases based on what he thinks the policy result should be or what the political stakes are for the court itself. He is a disgrace. That is all.

So there you have it. Roberts has now joined a long line of conservative sellouts, from Harry Blackmun to John Paul Stevens to David Souter. After Souter, Republicans swore this would never happen again and insisted on nominating only hardline conservatives with a long paper trail: Clarence Thomas, John Roberts, and Sam Alito. But now Roberts has let them down. It turns out that the ability to hold onto conservative principles while serving under Ronald Reagan is insignificant next to the power of the Washington DC cocktail party circuit.

Still, at least Republicans can now end their embarrassing charade of pretending to have a plan to fix things up if the court had ended Obamacare subsidies in states without their own exchanges. I think it's pretty safe to say that even the pretense of "working on" a plan to replace Obamacare will now be dumped quietly on the ash heap of history—until Republicans have a presidential nominee in hand, at which point the charade will have to start all over. But I think we already know what their bold new plan will contain. There are few surprises in the land of conservative ideas.

The Wit and Wisdom of Antonin Scalia, the Supreme Court's Lovable Curmudgeon

| Thu Jun. 25, 2015 1:34 PM EDT

Here is Antonin Scalia's dissent in the Obamacare case. Although Scalia would not approve, I have arranged the excerpts out of order so they make more sense and are more amusing. I have also eliminated all the legal arguments and other boring parts. You can always read the full opinion here if you want. For now, though, tell us what you really think, Mr Scalia:

Words no longer have meaning if an Exchange that is not established by a State is “established by the State.”

Yet the opinion continues, with no semblance of shame, that “it is also possible that the phrase refers to all Exchanges—both State and Federal.”

But normal rules of interpretation seem always to yield to the overriding principle of the present Court: The Affordable Care Act must be saved. [Scalia makes it clear throughout that he's still really pissed about losing the original Obamacare case in 2012. –ed.]

Contrivance, thy name is an opinion on the Affordable Care Act!

Faced with overwhelming confirmation that “Exchange established by the State” means what it looks like it means, the Court comes up with argument after feeble argument to support its contrary interpretation.

The Court’s next bit of interpretive jiggery-pokery involves other parts of the Act that purportedly presuppose the availability of tax credits on both federal and state Exchanges....Pure applesauce.

The somersaults of statutory interpretation they have performed...will be cited by litigants endlessly, to the confusion of honest jurisprudence. And the cases will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites.

We should start calling this law SCOTUScare.

Greece Gives Europe What It Wants, Europe Says No Anyway

| Thu Jun. 25, 2015 12:11 PM EDT

European leaders were in final, last-ditch, eleventh-hour, crisis talks with their Greek counterparts today, which by my count is at least the third time we've held final, last-ditch, eleventh-hour, crisis talks in the past two weeks. This leaves me a little unsure of when the real "world will explode" deadline is anymore. But soon, I'm sure.

In any case, as Paul Krugman notes, the Europeans are no longer merely demanding concessions of a certain size from the Greeks, they now want final say over the exact makeup of the concessions:

The creditors keep rejecting Greek proposals on the grounds that they rely too much on taxes and not enough on spending cuts. So we’re still in the business of dictating domestic policy.

The supposed reason for the rejection of a tax-based response is that it will hurt growth. The obvious response is, are you kidding us? The people who utterly failed to see the damage austerity would do — see the chart, which compares the projections in the 2010 standby agreement with reality — are now lecturing others on growth? Furthermore, the growth concerns are all supply-side, in an economy surely operating at least 20 percent below capacity.

Basically, the Europeans just can't seem to say yes even when they get what they want. Besides, although tax increases probably will hurt Greek growth, so will spending cuts. There's just no way around it. The Greek economy is completely moribund, and any kind of austerity is going to make it worse. But the Europeans want austerity anyway, and they have the whip hand, so now they've decided they also want to dictate the exact nature of the concrete life preservers they're throwing to Greece.

The Greeks have little choice left, unless they're willing to leave the euro, which would cause massive short-term pain at home. Maybe they will, but it would take a backbone of steel to do it. Voters would probably cheer raucously the first night, but be in a mood to vote the entire team out of office after about the second day, when their savings and pensions were converted into New Drachmas and suddenly slashed in half. There is no happy ending to this.

Obamacare Survives Supreme Court to Fight Another Day

| Thu Jun. 25, 2015 11:30 AM EDT

Hey, I finally got one right! The Supreme Court decided to keep Obamacare subsidies intact, with both Roberts and Kennedy voting with the liberal judges in a 6-3 decision. And apparently they upheld the subsidies on the plainest possible grounds:

Chief Justice Roberts wrote that the words must be understood as part of a larger statutory plan. “In this instance,” he wrote, “the context and structure of the act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.”

Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” he added. “If at all possible, we must interpret the act in a way that is consistent with the former, and avoids the latter.”

So this had nothing to do with the possibility that if Congress required states to build their own exchanges in order to get subsidies, that would be unconstitutional coercion on the states. That had been something a few of us speculated on in recent days. Instead it was a white bread ruling: laws have to be interpreted in their entirety, and the entirety of Obamacare very clearly demonstrated that Congress intended subsidies to go to all states, not just those who had set up their own exchanges.

So that's that. As far as I know, there are no further serious legal challenges to Obamacare. The only challenge left is legislative, if Republicans capture both the House and the Senate and manage to get a Republican elected president. So let's all hope that doesn't happen, m'kay?

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Health Insurance for All Is About a Lot More Than Just Health

| Wed Jun. 24, 2015 6:28 PM EDT

Megan McArdle writes today that there's little consistent evidence showing that giving people health insurance actually does much to save lives. This is based largely on a couple of recent papers (plus a few other older ones), and she's basically right. She's also right when she says that health insurance does save people lots of money. I don't want to address this literature in detail right now, but if you want to know more about it you should read Ezra Klein's post about this and then McArdle's response.

However, I do have some quick comments I want to add to this conversation. Some of it echoes what the other posts say, while some of it is new. Here it is:

  • The single biggest piece of evidence about the effect of health insurance is a study of Medicaid in Oregon a few years ago. It showed that people who randomly got Medicaid coverage didn't show much improvement in their health, nor did they live any longer than those without Medicaid.
  • However, as important as it was, the Oregon study was small; the time frame was short; the population was drawn entirely from the poor; and the results were ambiguous. Nobody should ignore this study, which was unique in being a true controlled trial, but no one should think it's the final word either.
  • The results of the Oregon study would probably not scale up. One way or another, Oregon's health care system can absorb a few thousand uninsured people. Some of the cost gets absorbed by hospitals that don't get paid. Some gets absorbed by local programs. Some gets absorbed by free clinics. It's a strain, but the system can handle it without breaking completely.
  • But this isn't an argument against health insurance generally. If half the state were uninsured, the system would almost certainly break down. There would simply be too many people who either couldn't or wouldn't pay for their care, and not enough people left over to absorb that cost.
  • Also, as I like to point out ad nauseam, there's more to health care than mortality. A dental filling won't extend your life, but it will sure make you feel better. Ditto for a hip replacement or an antidepressant.
  • Health insurance is a financial lifeline, and in many cases prevents bankruptcy. But there's more. It's also a huge reliever of stress. Trying to cobble together care from a complicated, ad hoc network of clinics, ERs, doctors who don't want to see you, and friends who can loan you a few bucks is soul destroying—especially for people whose lives probably kind of suck to begin with.

In the end, I think this is what health insurance is mostly about: financial security and common decency. Yes, the uninsured can usually patch together health care in an emergency, and sometimes even when it's not. This is why access to health insurance probably has only a modest effect on health. (Though I don't believe it's zero. If we could do a bigger, better, longer-term study we'd almost certainly see a difference.) Still, is a constant, desperate search for health care really a decent thing to tolerate in the richest country in the world? Is relentless, gnawing worry about whether to buy food this week or take your child in for a checkup a decent thing for us to tolerate? Is an endless, threatening barrage of harassment from hospital bill collectors a decent thing for us to tolerate?

It kills me that some people think it's just fine to tolerate this—among the poor, anyway. It's true that there are lots of things that are inevitably going to afflict the lives of the poor. Compared to the better off, they'll have worse food, worse housing, worse cars, and worse clothes. But should they have worse health care? That's a moral question, not a scientific one. And my moral compass says that health care is one of the things all of us should have decent, regular access to. In fact, it makes me a little sick to my stomach every time I have to face up to the fact that a lot of moral compasses here in America apparently don't agree.

It's Time for Another Obama Apology Tour

| Wed Jun. 24, 2015 1:49 PM EDT

Here's our latest "crisis":

French President Francois Hollande held a crisis meeting of the country's Defense Council on Wednesday after newspapers published WikiLeaks documents showing that the United States eavesdropped on him and two predecessors.

After the meeting, the council issued a statement lambasting U.S. spying as "unacceptable" and declaring that France had demanded two years ago that the National Security Agency stop snooping on its leaders. The latest WikiLeaks revelations, published by the daily newspaper Liberation and the investigative news website Mediapart, claim the NSA eavesdropped on telephone conversations of former Presidents Jacques Chirac and Nicolas Sarkozy as well as Hollande.

Look, can't we just assume the NSA has been spying on every world leader around the globe? Clearly, the answer is for President Obama to put this finally to rest by embarking on an apology tour of the entire planet—except for leaders we don't like and plan to keep spying on. This will accomplish two things: (a) it will take care of the whole spying thing all at once, instead of having it dribble out every month or two, and (b) Obama really would go on an apology tour, which would make Republicans deliriously happy. Finally they'd be able to accuse him of going on an apology tour and they wouldn't even have to lie about it. How cool is that?

Then, when it's all over, we can go back to spying on everyone, except more carefully. I mean, you didn't really think we were going to stop spying on these guys, did you?

The Rest of the World Is Pretty Happy With President Obama's Handling of World Affairs

| Wed Jun. 24, 2015 12:36 PM EDT

President Obama has had his ups and downs on the world stage. Libya didn't turn out so well. There's been no progress between Israel and the Palestinians. Vladimir Putin continues to be annoying. Still, all things considered, he hasn't done badly. He's started some new wars, but none as horrifically bad for US interests as George Bush's. He appears to have managed passage of the Trans-Pacific Partnership. He negotiated the NEW START treaty with Russia. He's mostly stayed out of Syria, despite endless braying from Republicans. The pivot to Asia has been moderately successful. And he might yet sign a treaty that will halt Iran's nuclear bomb program, though it still looks like no more than a 50-50 proposition to me.

But enough about me. What does the rest of the world think of Obama? According to a new Pew poll, they think surprisingly well of him. Obama's foreign policy is astonishingly well regarded in France, Italy, and Germany—and surprisingly, although his numbers are down from last year, he still does reasonably well in Israel too. And here I thought Obama was universally hated in Israel because he had betrayed them to their enemies thanks to his preoccupation with sucking up to Muslims. I guess that'll teach me to listen to Republicans.

Obama bombs in a few countries too, notably Russia, Jordan, and Pakistan. Russia and Pakistan are easy to understand, but what's the deal with Jordan? I don't quite remember what we've done to piss them off.

China is surprisingly positive: 44-41 percent approval. The rest of Asia is strongly positive, probably because they trust Obama to stand up to China.

Anyway, Obama's median approval throughout the world is a surprisingly healthy 65-27 percent. He could only wish for such strong approval at home.

Home Weatherization Not As Good a Deal As We Thought

| Wed Jun. 24, 2015 11:48 AM EDT

Brad Plumer passes along some bad news on the effectiveness of residential energy efficiency upgrades. A massive controlled test in Michigan showed that it doesn't pay for itself:

The researchers found that the upfront cost of efficiency upgrades came to about $5,000 per house, on average. But their central estimate of the benefits only amounted to about $2,400 per household, on average, over the lifetime of the upgrades. Yes, the households were using 10 to 20 percent less energy for electricity and heating than before — but that was only half the savings that had been expected ahead of time. And households weren't saving nearly enough on their utility bills to justify the upfront investment.

The culprit appears to be the real world. Engineering studies suggest that residential upgrades should pay for themselves in lower energy costs within a few years, but in real life the quality of the upgrades is never as good as the engineering studies assume:

These engineering studies may not always capture the messiness of the real world. It's easy to generate ideal conditions in a lab. But outside the lab, homes are irregularly shaped, insulation isn't always installed by highly skilled workers, and there are all sorts of human behaviors that might reduce the efficacy of efficiency investments.

....In this particular study, the economists found that the federal home weatherization program was not a particularly cheap way to reduce CO2 emissions. Although energy use (and hence carbon pollution) from the homes studied did go down, it came at a cost of about $329 per ton of carbon. That's much higher than the $38-per-ton value of the social cost of carbon that the US federal government uses to evaluate cost-effective climate policies.

Back to the drawing board.