Kevin Drum

Medicaid Expansion Is a Stealth Success, and That's Just Fine

| Mon Jan. 6, 2014 12:14 PM EST

Obamacare ended the year with about 2 million people who signed up through the insurance marketplaces and maybe three times that many who signed up for Medicaid. That makes the Medicaid expansion a big success, but neither party really wants to admit it:

To Drew Altman, president of the Kaiser Family Foundation, this exposes a core reality of U.S. health-care politics. “Republicans don’t like entitlement programs, and Democrats want to portray the ACA as mostly a marketplace solution based on private insurance and not another expansion of a government program,” he said, “so neither side wants to emphasize the ACA’s success enrolling people in Medicaid even though it may be the law’s biggest achievement so far in terms of expanding coverage.”

This has left both the Obama administration and Republicans in a tight spot. The White House can’t really tout the Medicaid expansion because it’ll revive fears on the right that Obamacare is really a stealthy effort to create a single-payer health-care system, and it’ll arouse criticism on the left that the administration should have expanded Medicaid to all.

As for Republicans, they can’t admit the Medicaid expansion is going well because doing so is dangerously close to advocating a single-payer health-care system. The exchanges, marred by their troubled introduction, are also a problem as they are a Republican idea, enshrined in Rep. Paul Ryan’s health-care bill.

I think I'd analyze this a bit differently. I don't really have a sense that much of anyone associates Medicaid expansion with a push for single-payer. Rather, Democrats don't want to talk about it because Medicaid is a program for the poor, and they don't want middle-class voters thinking that Obamacare is just another way to funnel their tax dollars into welfare programs for other people. Likewise, Republicans oppose Medicaid expansion simply because they don't like entitlement programs; they don't like higher taxes; and they've always wanted to block-grant Medicaid and starve it to death. I don't think it's really any more complicated than that.

In any case, I'm fine with this. I think Medicaid expansion is great, but unlike a lot of lefties, I also think it's a dead end. It's not going to lead to single-payer, and it's never going to be a template for future health care reforms. The marketplaces, despite all their problems, have far more potential to eventually lead to health care coverage for all. I think they also have more potential to produce delivery reforms down the road and to rein in cost growth. For that reason, I'm OK with the Medicaid expansion staying under the radar. That's a fine place for it.

Advertise on

Friday Cat Blogging - 3 January 2014

| Fri Jan. 3, 2014 3:55 PM EST

Domino is exhausted from an entire year of posing with quilts, so she's upstairs taking a well-deserved nap. Instead, we have a guest cat to kick off the new year. This is a friend's feline furball, cleverly named Grayson. Handsome little beast, isn't he?

Chart of the Day: American Cars Are Getting Older

| Fri Jan. 3, 2014 3:27 PM EST

Americans are keeping their cars longer than ever before. In 2007, the average age of cars on the road was a little over 10 years. Today it's a little over 11 years.

The proximate cause of this is the Great Recession. If you don't have enough money to buy a new car, you're going to keep your car longer. But I wonder how much is the result of cars being more reliable than in the past? My car is nearly 13 years old, and it basically still runs fine. A couple of decades ago, even a Toyota would have been getting a little long in the tooth at that age.

This mainly matters because it has an impact on what happens over the next few years as the recovery (hopefully) picks up steam. New car sales are a prime driver of economic recoveries, and if the aging of the US fleet is producing pent-up demand for new cars, this will help the economy. But if consumers are keeping their cars a little longer because they still run fine, then there might not be as much pent-up demand as we think.

We'll have to wait and see, because current data is inconclusive. Automakers had a pretty good year in 2013, but they finished up with a tepid December. And the existing fleet continued to age in 2013 despite those strong sales. Considering the higher reliability of modern cars and the weakness of the recovery, I wouldn't be surprised if car sales in 2014 are OK but not great, and the fleet continues to age a bit.

Year-End Whining Gets Results!

| Fri Jan. 3, 2014 2:05 PM EST

Normally, my blog whining produces no results worth mentioning. But last month was different: two, count 'em, two of my whines got results. This is easily a new personal best.

First up: I complained bitterly that Charlie Stross's newly revised Merchant Princes series was available in Britain but not in the US. I understand why the publishing schedule for the physical books might be off in the future, but why not release the e-versions? Well, the estimable Patrick Nielsen Hayden of Tor Books heard my lament and sprung into action. As a result, digital versions of these books will be available in the United States next Tuesday, January 7. Details and links here.

Second: I expressed surprise that no one was talking yet about Thomas Piketty's new book, Capital in the 21st Century. Sure, it's only available in French at the moment, but there must be at least a few economists who read French and have something to say about it. Right? Well, Brad DeLong, who (a) reads French, (b) also happens to have on hand a manuscript of the English translation, and (c) has read the PowerPoint notes for a lecture Piketty gave based on his book, provides us with a synopsis of Piketty's findings:

  1. As growth rates decline in the Old World (Europe and Japan), we will once again see the dominance of capital: a greater proportion of the wealth of society will be held in the form of physical and other non-human-skill assets, and inheritance and position will matter more and individual effort and luck less.
  2. In fact, given relatively high average rates of return on capital and thus a large gap vis-a-vis the growth rate, wealth concentration is likely to reach and then surpass peak levels seen in previous history as the superrich become those who started wealthy and benefitted from compound interest and luck.
  3. America remains an exceptional puzzle: it looks, however, like it is headed for an even more extreme distribution of wealth than is the Old World.
  4. Remember, however: the evolution of income and wealth distributions is always political, chaotic, unpredictable--and nation-specific: not global market conditions but national identities rule wealth distributions.
  5. High wealth inequality is not due to any "market failure": this is a market success: the more frictionless and distortion-free are capital markets, the higher will wealth inequality become.
  6. The ideal solution? Progressive global-scale wealth taxes.

There's much more at the link, including the complete set of slides from Piketty's talk. Or you can wait until March when the English translation comes out and everyone dives in.

I am excited that my end-of-year whining has produced such stunning results. All that's left is to figure out if this is just a coincidence, or if my whining has somehow become more effective lately. Perhaps I should whine more to find out?

Movies, Movies Everywhere, But Not a Drop to Watch

| Fri Jan. 3, 2014 1:16 PM EST

Netflix has developed an awesomely sophisticated stockpile of data about what kind of movies people want to watch. This sounds like a huge advantage for them—and it is—but Felix Salmon argues that it's also a sign of weakness. Netflix has to mine this information because its streaming service has such a paltry collection of titles:

If you give Netflix a list of all the movies you want to watch, the proportion available for streaming is going to be so embarrassingly low that the company decided not to even give you that option any more....So Netflix has been forced to attempt a distant second-best: scouring its own limited library for the films it thinks you’ll like, rather than simply looking for the specific movies which it knows (because you told it) that you definitely want to watch. This, from a consumer perspective, is not an improvement.

I figure there are two basic kinds of customers here. The first has specific movies she wants to watch, and tries to find them. The second just wants to watch something decent, and will browse around looking for something that fits the bill. I gave up on Netflix streaming years ago because I'm the first kind of person, and I almost always came up blank when I searched for something specific. Netflix, as Salmon says, has pretty much gone all-in on the second type:

The original Netflix prediction algorithm — the one which guessed how much you’d like a movie based on your ratings of other movies — was an amazing piece of computer technology, precisely because it managed to find things you didn’t know that you’d love. More than once I would order a movie based on a high predicted rating, and despite the fact that I would never normally think to watch it — and every time it turned out to be great. The next generation of Netflix personalization, by contrast, ratchets the sophistication down a few dozen notches: at this point, it’s just saying “well, you watched one of these Period Pieces About Royalty Based on Real Life, here’s a bunch more”.

Netflix, then, no longer wants to show me the things I want to watch, and it doesn’t even particularly want to show me the stuff I didn’t know I’d love. Instead, it just wants to feed me more and more and more of the same, drawing mainly from a library of second-tier movies and TV shows.

Yep. What I wonder is what happens when Netflix eventually drops the disc-by-mail service that gave it its start. That's inevitable, isn't it? And when it happens, it will mean there's really no place left to find a large selection of older movies to watch. The old brick-and-mortar stores will be gone, driven out of business by Netflix, and thanks to licensing wars, no streaming service will be available with a broad selection. People like me will actually be worse off than we were a decade ago.

Eventually that will change. I hope. But in the meantime, it's slim pickings.

Does More Marijuana Smoking Mean Lower Attendance at the Opera?

| Fri Jan. 3, 2014 11:49 AM EST

David Brooks smoked marijuana in his youth, but then got bored with it and stopped. He says it never seemed like a very uplifting pastime, and this makes him nervous about about legalization:

I don’t have any problem with somebody who gets high from time to time, but I guess, on the whole, I think being stoned is not a particularly uplifting form of pleasure and should be discouraged more than encouraged.

We now have a couple states — Colorado and Washington — that have gone into the business of effectively encouraging drug use. By making weed legal, they are creating a situation in which the price will drop substantially. One RAND study suggests that prices could plummet by up to 90 percent, before taxes and such. As prices drop and legal fears go away, usage is bound to increase. This is simple economics, and it is confirmed by much research. Colorado and Washington, in other words, are producing more users.

....I’d say that in healthy societies government wants to subtly tip the scale to favor temperate, prudent, self-governing citizenship. In those societies, government subtly encourages the highest pleasures, like enjoying the arts or being in nature, and discourages lesser pleasures, like being stoned.

Brooks' column is getting a lot of mockery in my Twitter feed, but for once I guess I can't really join in. It's not that I agree with Brooks—and I'll concede that his comparison of pot smoking with "higher pleasures" is kind of silly. But for the most part, all his column does is express a fairly modest sense of unease about the fact that legalization will almost certainly increase pot smoking a fair amount. There's really nothing wrong with being a little nervous about that. These new laws will increase marijuana use.

But the big thing Brooks misses is the question of whether this will increase overall intoxication. It might. Alternatively, marijuana might largely displace alcohol use, producing little or no net increase in intoxication but producing a safer society overall since pot tends to be less damaging than alcohol. In the lingo, this is a question of whether marijuana and alcohol are economic substitutes or economic complements, and the research on this point is inconclusive. One of the great benefits of legalization in Washington and Colorado is that it will finally start to give us some decent data on this. For various reasons, it won't settle the question definitively, but two or three years from now we'll certainly have a much better idea than we do today about the net effect of marijuana legalization.

And if it turns out that legalizing pot reduces alcohol use? Then Brooks should be happy. There will still be plenty of idiots getting drunk and stoned, but there won't be any more than there are now. We'll have an increase in personal freedom; a reduction in drug war costs; and no significant change in the number of people pursuing higher pleasures. It's well worth finding out if this will be the case.

Advertise on

Chart of the Day: Fewer People Are Being Sent to Prison. Way Fewer.

| Thu Jan. 2, 2014 9:08 PM EST

If banning leaded gasoline—and thus reducing childhood exposure to airborne lead—leads to less violent crime when all those children grow up, shouldn't it also lead to a smaller prison population? Yes it should. But there are problems. First, prison sentences tend to be long, so even when the number of new offenders began to decline in the 90s, we were still adding to a prison population that included lots of offenders from the 80s who weren't going to be released anytime soon. So the prison population continued to grow. Second, the great crime wave of the 70s and 80s spawned an enormous public policy reaction. Courts got tougher, sentences got longer, and things like three-strikes laws became commonplace. So even as violent crime rates declined, more suspects were caught and convicted, and a larger percentage of them were given long prison sentences.

But eventually incarceration rates were bound to catch up anyway. After all, there's a limit to how many new cops you can put on the streets and how much tougher you can make sentencing policy. So have they? Unfortunately, total prison population tells us more about policies and crime rates in the past, when today's prisoners were first incarcerated, than it does about today. So Keith Humphreys decided instead to take a look at new prison admissions. He was pleased with what he found:

I was startled and encouraged to see that under current policies, we are at a two decade-year low in the prison admission rate. To provide historical perspective, peg the change to Presidential terms: When President Obama was elected, the rate of prison admission was just 3% below its 2006 level, which was very probably the highest it has ever been in U.S. history. But by the end of Obama’s first term, it had dropped to a level not seen since President Clinton’s first year in office.

As dramatic as these changes are, the prison population would be declining even faster if we fully accepted the logical consequence of the lead-crime hypothesis: not just that violent crime rates have plummeted over the past two decades, but that they're likely to stay low. The problem is that our sentencing and incarceration policies are a vestige of an era when violent crime was rampant and only a harsh and iron-fisted response seemed to have any chance of stopping it. But we no longer need those policies. We could return to a less severe approach without endangering public safety if only we had the will to do it. America's young simply aren't as violent as they used to be.

Not convinced yet? Here's some further data from Rick Nevin:

From 2002 to 2012, the incarceration rate fell 51% for men ages 18-19, 30% for men ages 20-24, and 21% for men ages  25-29....The prison population has fallen at a slower rate because steep incarceration declines for young men have been offset by rising incarceration for older adults.  From 2007 to 2012, the incarceration rate increased by 21% for men ages 45-49 and surged 45% for men ages 50-64.

Incarceration rates are way down for men in their teens and 20s, who grew up in the relatively lead-free post-1990 environment. But for older men, who grew up before then, incarceration rates are actually up. Lead did its work on them long ago.

Republicans Might Accept Obamacare Someday, But It Won't Be Anytime Soon

| Thu Jan. 2, 2014 4:15 PM EST

Greg Sargent sees a light at the end of the Obamacare tunnel. Until now, the GOP's only goal has been repeal. But as 2014 wears on, it's going to become increasingly obvious that Obamacare is here to stay. What happens then?

If Republicans do get to a point where crippling or eliminating the law is not the only acceptable outcome, there are scenarios under which they might negotiate for certain types of changes to the law, in exchange for changes Dems or liberals want.

Larry Levitt of the Kaiser Family Foundation laid out the types of incremental changes Republicans might pursue. He suggested Republicans might propose various ways of relaxing Obamacare’s regulations, in keeping with conservative policy ideas, that wouldn’t destroy the law. For instance, they could propose allowing insurance sales across state lines so competition drives down prices, something liberals might be willing to accept under certain circumstances if the law’s uniform federal minimum coverage standards are kept (which could theoretically prevent the “race to the bottom” liberals fear).

There are other possibilities too. Sargent acknowledges that none of this will happen in 2014, and possibly not until after 2016 too. That's my guess as well. And even then, there will probably be only minimal Republican appetite for dealmaking. After all, Medicaid is more than half a century old, and Republicans still aren't willing to cut deals that might strengthen it in return for some conservative policy advances. In fact, they're still dead set on block granting Medicaid as a way of slowly starving it to death.

Obamacare could be different if it becomes widely used by the middle class, not just the poor. Republicans would have a hard time resisting middle-class demands to improve the program. But that's what it will take. And I'd guess that 2017 is about the earliest likely date for Republicans to give up their dream of total repeal.

When There's a News Scandal, You Can Count on News Organizations to Clam Up

| Thu Jan. 2, 2014 3:05 PM EST

Erik Wemple's year-end roundup column focuses on one of my pet peeves: the almost total lack of transparency from news organizations that routinely demand transparency from everyone else. One of Wemple's observations is that this is a bigger problem on TV than it is elsewhere:

Whatever their relative merits on openness, TV outlets keep a tighter lid on information than, say, newspapers or Web outfits, those radical organizations that occasionally allow their reporters to simply hop on the phone and speak about their jobs! The New York Times’s Carr tells the Erik Wemple Blog, “I think that’s because people [in TV] see themselves as talent, and not journalists.” Those “talent” people, too, know better than to shirk the folks in the media department. On those occasions when the Erik Wemple Blog manages to get face to face with broadcast types, they’re generally very diligent about referring us to their PR overseers.

The bulk of the column is devoted to various media transgressions that resulted in refusals to comment; anodyne "statements"; and flat claims that nothing could possibly be amiss in the first place. For example:

On Oct. 27, “60 Minutes” aired its now-infamous investigation on Benghazi....The Huffington Post’s Michael Calderone documented the stonewalling that he received upon pressing CBS News about the discrepancies....“60 Minutes” more recently took a beating for its coverage of the National Security Agency...Let’s turn to correspondent Sharyl Attkisson....Fox News in 2008 planted a false tip with a reporter who was working on a story about the ratings success of CNN. After the reporter published a piece based on the tip, Fox News trashed him.

And so on. The whole column is worth a read. News organizations aren't shy about insisting on accountability from everyone else. They should provide a little more of it themselves.

If You Think the NSA Debate Has Been Valuable, You Have Edward Snowden to Thank

| Thu Jan. 2, 2014 1:26 PM EST

Ruth Marcus thinks Edward Snowden is "insufferable," and I guess that's fine. I'll concede that Snowden's personal demeanor has set me on edge once or twice, so I can understand why he might aggravate people of a certain temperament.

But then there's this:

Personality would not matter — at least it would not be so grating — if Snowden’s behavior were more upstanding and his actions more justified. On behavior, if Snowden is such a believer in the Constitution, why didn’t he stick around to test the system the Constitution created and deal with the consequences of his actions?

The harder question, because the cost-benefit analysis is inherently both opaque and subjective, concerns the actions themselves....Your assessment might be different. My scale weighs against Snowden. He launched an important, overdue debate and reassessment of collection practices. Perhaps that would not have happened otherwise. The intelligence community is reaping the bitter rewards of its combined aversion to transparency and its addiction to employing available technology to maximum potential.

On Marcus's first question: come on. If it were a matter of sticking around and facing the possibility of a few years in prison, that would be one thing. Maybe we should feel that Snowden should have been willing to accept the consequences of his actions. But that was never in the cards, and surely Marcus knows it. In reality, Snowden was facing the near certainty of decades or more in Supermax solitary confinement. There's just no way you can pretend that an unwillingness to surrender to torture of that magnitude says anything about how upstanding you are or how strongly you believe in the Constitution.

Marcus's second point is even more peculiar. Why does she say that "perhaps" there would have been no debate without Snowden? Is that even an arguable position? I'd say that without Snowden, there was zero chance of any serious discussion of NSA surveillance taking place. Regardless of what you think about Snowden personally, you have him to thank if you believe this debate has been valuable. If it had been left up to President Obama and the security establishment, we wouldn't know a hundredth of what Snowden has revealed.

I wouldn't defend every last thing Snowden has done. But life is messy, and you don't always get to control events with precision. Realistically, your choice is between (a) approving of what Snowden did, warts and all, or (b) approving of the status quo, with all of us none the wiser about what our government is doing. I'd say the choice is obvious.