Kevin Drum

Do Republicans Want High Deductibles or Low Cost? It's Time to Choose, Folks.

| Thu Dec. 12, 2013 1:08 PM EST

I've been slightly baffled by the latest Republican attack on Obamacare, namely that the private insurance plans on the exchanges tend to have pretty high deductibles. Say what? Last month, the attack line du jour was exactly the opposite: Obamacare premiums were too high because it set such low requirements for deductibles and out-of-pocket caps. So which is it? Should we allow higher deductibles in return for lower premiums? Or should we require even lower deductibles and accept higher premiums in return? There's not really any third option.

But that's not the only bit of hypocrisy at play here. There's also the fact that Republicans love high deductibles. I'll let Ezra Klein do the honors:

What's confusing about this line of attack is that high-deductible health-care plans — more commonly known as "health savings accounts" — were, before Obamacare, a core tenet of Republican health-care policy thinking. In fact, one of the major criticisms of Obamacare was that it would somehow kill those plans off. "Obamacare may be fatal for your HSA," warned the Heritage Foundation on 2010. "Health Savings Accounts Under Attack" blared Red State.

When Republicans were forced to come up with alternatives for Obamacare, high-deductible plans were core to those proposals. "Conservatives have suggested deregulating Obamacare’s exchanges to make it easier to provide policies with high deductibles," wrote Ramesh Ponnuru....This always baffled Obamacare's supporters. "The minimal, or bronze, insurance option allows out-of-pocket spending of up to $12,500 for a family of four," wrote Jonathan Cohn. "Those are some pretty high deductibles!"

Now that those high deductibles are here, Republicans have decided that they are, if anything, too high. Just one more broken promise.

I don't want to pretend to some kind of faux naivete here. It's obvious what's going on: there are lots of things that are unpopular about health care, and Republicans are trying to blame them all on Obamacare. If I were in their shoes, I'd do the same. I'd complain that restrictions were too tight and that costs were too high. I'd complain that old plans with high deductibles were being canceled and that new plans with lower deductibles were still too high. Etc.

That's politics for you. But make no mistake: Republicans have spent years claiming that their preferred health care solution involves a combination of high-deductible health plans and tax-free HSAs. The idea is that your HDHP handles catastrophic illnesses, while the money you use for routine medical care isn't taxed, which puts it on a par with employer health care.

But their idea of "high deductible" has always been on the order of a few thousand dollars. A bronze plan under Obamacare typically has a deductible of $5,000 or more ($10,000 or more for a family). And while Obamacare doesn't feature tax-free HSAs, it does feature annual premiums with much of the cost offset via tax credits. Conservatives will never admit this (and maybe not liberals either), but the end results aren't really all that dissimilar.1

In any case, there's never any free lunch. If you want a better health plan, you'll have to pay more. You can complain about narrow networks or you can complain about cost. You can complain about high deductibles or you can complain about cost. You can complain about tighter coverage requirements or you can complain about cost. But you really can't complain about both.

1Obamacare also features community rating and an individual mandate, in addition to a bunch of miscellaneous new regulations for minimum coverage. Those are big deals, and I don't want to make it seem as if Obamacare and HDHP/HSA plans are pretty much the same. However, in terms of deductibles and tax advantages, they aren't that different, especially compared to conservative plans that also feature low-income subsidies and individual mandates of some kind.

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Democrats in Tough Races Need to Stick Up For Obamacare

| Thu Dec. 12, 2013 11:56 AM EST

Greg Sargent reports on the latest polling in battleground districts:

Top Democratic pollster Stan Greenberg — having just done extensive polling in 86 competitive House districts — is advising Dems they should go on offense over the Affordable Care Act. The key finding: Even though voters in the battlegrounds have extreme doubts about the law, they still prefer implementing it to the GOP stance of repeal. And after a month of crushingly awful press for Obamacare, opinions on this matter in the battlegrounds have barely budged since October.

....Offered a straight choice between “implementing and fixing” the health law and “repealing and replacing” it, voters in these 86 districts prefer “implementing and fixing” by five points, 49-44. That’s only a slight difference from October, when implement and fix led by seven, 51-44.

For a variety of reasons, I think this is good advice. At the most basic level, voters prefer candidates who stick up for what they believe, even if they don't entirely agree with them. The worst possible position is to vote for something and then waffle around about whether you're ready to stand behind it.

That said, these results aren't surprising. They're about the same as every national poll I've seen for the past year. The numbers vary a bit from poll to poll, but there's virtually always (a) a small majority who either support Obamacare as is or want it expanded into something even more liberal, and (b) a small majority who prefer keeping it to repealing it. The first result varies depending on question wording, but the second one never does. Even in polls that show a majority opposed to Obamacare, you almost always get a majority (or a plurality) who are also opposed to ditching it outright.

These poll results sound about right to me, and I suppose members of Congress like to see polling in their district that confirms national trends. Still, the national trend has never been for repealing Obamacare. Some of that may be status quo bias, and some may be a recognition that Republicans have no credible alternative, but it's been pretty consistent for years now.

Vermont Is Kicking Everyone's Ass at Signing Up People for Obamacare

| Thu Dec. 12, 2013 1:50 AM EST

Which states are doing the best at signing up people for Obamacare? Business Insider has a state-by-state chart here showing the number of people who have completed the process 100 percent: they've actually chosen a specific plan and officially enrolled their families. But I figure a better measure of activity is the number of people who have completed an application and been confirmed eligible to purchase private insurance via the exchange. They still have the final enrollment step left, but they've obviously navigated everything successfully, which is a good measure of how smoothly things are rolling out.

The chart below shows the results for 49 states (there's no data for Massachusetts). States in red are running their own websites. States in blue are using the federal website. Vermont and Kentucky are way ahead of everyone else, and demonstrate how well the Obamacare rollout is doing in places where the website is working and the state government is doing a good job of marketing and operations. Raw data comes from today's HHS report.

GOP Plan to "Punish" Democrats Is Probably the Stupidest Thing You've Ever Heard Of

| Wed Dec. 11, 2013 7:19 PM EST

Ed Kilgore highlights what must be the dumbest, whiniest, most ineffectual "protest" ever. Ladies and gentlemen, the Senate Republican caucus:

Senate Republicans will stage a more than 30-hour talkathon on the Senate floor to protest Democrats’ triggering of the "nuclear option" last month. The GOP protest, which could extend into the weekend, will throw a wrench in Senate Majority Leader Harry Reid’s (D-Nev.) hopes of wrapping up legislative business for 2013 as soon as possible.

Republicans will delay a final vote on Cornelia Pillard, one of President Obama’s picks for the D.C. Circuit Court of Appeals, until about 1 a.m. Thursday. Then, Senate Republicans will hold the floor throughout the night, speaking out against Reid’s use of the nuclear option.

....“When you blow up the Senate rules, there has to be a consequence,” said a Republican senator. “We’ll stretch this into the weekend if need be,” said the GOP lawmaker.

Seriously? They're going to thunder away to an empty chamber in order to "punish" Democrats by forcing them to the floor at 1 am for a vote? That'll show them! And then they're going to thunder some more in order to—what? Delay everyone's Christmas shopping?

Yeesh. Even the most moronic of the tea partiers isn't going to be impressed by this display of buffoonery. Get a grip, folks.

Attention Econ Nerds: FRED Has Updated Its Graphing Capability

| Wed Dec. 11, 2013 6:46 PM EST

There are still a few bugs in the system, and you lose some control over presentation when you directly embed their code, but the fine folks at Federal Reserve Bank of St. Louis have added a few snazzy little features to their FRED graphing program. You can see what it looks like in the example below, which shows GDP per capita since 2004—and illustrates just how long it's taken us merely to get back to the level of 2007. The timeline control at the bottom is new: if you want to see this data for any other decade, or for multiple decades, just drag the year markers. The y-axis gets a little wonky when you do this, but this is just a beta version, so a few bugs are to be expected.

At the moment, unfortunately, the embedding function seems to be working sort of sporadically. If you see "Proxy Error" instead of a graph, click refresh and try again. Then try yet again. Like, I'm sure it will work reliably soon enough.

This has been your stats nerd update for the day.

There's a New Farm Team in Conservative Media Land

| Wed Dec. 11, 2013 3:33 PM EST

A regular reader writes:

It would be interesting to explore the business strategy decision that's had the Daily Mail regularly making stuff up to feed to Fox and the rest of U.S. right-wing nutjob media, but more and more often the freakouts seem to originate with them.

Huh. That would be an interesting thing to look into. This observation struck me because I've sort of vaguely noticed the same thing, but never put two and two together. And yet, there seems to be something to it.

The latest offering from the Mail is a piece suggesting that Obamacare is going to decimate volunteer fire departments throughout the country. My friend's email continues:

Don't know if you've ever lived in an area that relies on a volunteer fire department, but since I now do, I can tell you these incredibly skilled and brave neighbors and friends are regarded (rightly) as incredible, nearly God-like heroes. I can't think of anything more likely to send rural and small-town (and largely right-wing) America into a complete tizzy than the threat of Big Gummint crashing down on the local volunteer fire department.

So far, the Mail piece has been reprinted at Fox Nation and a few other places, but doesn't seem to have gone viral in right-wing precincts yet. Maybe it never will. After all, reading between the lines, it appears that this is (a) only a potential problem, and (b) only if the IRS classifies volunteers as employees. It hasn't actually done that yet, and probably won't, in which case the whole problem melts away.

Nonetheless, the U.S. version of the Mail really does seem to have begun working as sort of a farm team for Fox and Drudge and all the rest. Maybe that was inevitable given their shared ideology, but it would be worth reading more about this from someone who tracks the media more closely than I do.

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The War Over Austerity Is Over. Republicans Won.

| Wed Dec. 11, 2013 2:32 PM EST

The main thing you need to know about today's budget agreement is that it's very modest. It repeals a little bit of the sequester cuts, and pays for it with a few small cuts in entitlements and some even smaller increases in user fees. Overall, the numbers are tiny enough that it's hard to see how anyone can get either too excited or too outraged over it.

Needless to say, this hasn't stopped the usual suspects (Heritage, Club for Growth, various tea party groups) from acting as though it represents the end of Western civilization. But they've overplayed their hands this time, and GOP leaders in the House have apparently had enough of these clowns. Both John Boehner and Eric Cantor essentially told them to piss off, and I suspect that this agreement is going to get a lot of Republican votes. I'll predict at least 150 Republican votes in the House, maybe more. The tea party rump is truly going to be a rump this time.

That said, it was interesting reading the reaction of conservative wonk-star Yuval Levin to the deal:

This deal would amount to the Democrats accepting the implications of their misjudgment in abiding the Budget Control Act in 2011....It doesn’t much change the terms reached in the original Budget Control Act and sequester deal, and essentially cements the Democrats’ loss and miscalculation in that deal.

The Democrats’ hope, given that they control both the White House and the Senate, was to replace the sequester with some combination of tax increases and more palatable spending cuts....That the Democrats would accept a deal like this is a pretty striking indication of how the Republican House has changed the conversation on the spending front since 2010. Think of it this way: In their first budget after re-taking the majority—the FY 2012 Ryan budget, passed in 2011—the House Republicans wanted discretionary spending to be $1.039 trillion in 2014 and $1.047 trillion in 2015. These budgets were of course described by the Democrats and the political press (but I repeat myself) as some reversion to humanity’s barbaric past. Yet this proposed deal with the Democrats would put discretionary spending at $1.012 trillion in 2014 and $1.014 trillion in 2015—in both cases below that first House Republican budget.

To some extent, Levin is probably overstating his case in order to nudge conservatives on board a deal he thinks is palatable—and away from yet another round of government shutdowns, which he correctly views as disastrous for Republicans. Still, he's basically right: Democrats originally believed the sequester would never happen. Either the supercommittee would replace it, or else Republicans would eventually cave in because they couldn't tolerate the defense cuts. But that turned out not to be true. They aren't happy with the defense cuts, but in the end, to the surprise of Democrats, they've decided they can live with them.

The ultimate result, as Levin says correctly, is a budget that's below even the pipe-dream Ryan budget of 2011. I'd make a bit less of this than Levin, since Ryan's budgets have always backloaded their cuts, but it's still pretty remarkable. Two years ago, Ryan's budget was basically at the outer limit of mainstream conservative wish lists. Today it looks tame.

Quibbles aside, Levin is right: Republicans have massively changed the spending conversation since 2010. Austerity has won.

A Conservative Diagnoses the Decay of American Political Institutions

| Wed Dec. 11, 2013 1:15 PM EST

Via Tyler Cowen, Francis Fukuyama diagnoses three things that are driving the decay and sclerosis of the American political system:

The first is that, relative to other liberal democracies, the judiciary and the legislature (including the roles played by the two major political parties) continue to play outsized roles in American government at the expense of Executive Branch bureaucracies....Over time this has become a very expensive and inefficient way to manage administrative requirements.

The second is that the accretion of interest group and lobbying influences has distorted democratic processes and eroded the ability of the government to operate effectively.

....The third is that under conditions of ideological polarization in a federal governance structure, the American system of checks and balances, originally designed to prevent the emergence of too strong an executive authority, has become a vetocracy....We need stronger mechanisms to force collective decisions but, because of the judicialization of government and the outsized role of interest groups, we are unlikely to acquire such mechanisms short of a systemic crisis. In that sense these three structural characteristics have become intertwined.

I'm not entirely persuaded about Fukuyama's second point. There's not much question that lobbying has exploded over the past half century, nor that the rich and powerful have tremendous sway over public policy. But do powerful interest groups really have substantially more influence in the United States than in other countries? Or do they simply wield their power in different ways and through different avenues? I'd guess the latter.

Nonetheless, even if America's powerful are no more powerful than in any other country, the fact that they wield that power increasingly via Congress and, especially, the judiciary might very well make their influence more baleful. I'm reminded of an argument from labor attorney Thomas Geoghegan along similar lines. Obviously he allocates blame a little differently than Fukuyama does, but he still concludes that the explosive growth in litigation to solve problems has had pernicious consequences. In the case of workplace complaints, for example, quick and simple arbitration has been largely replaced by scorched-earth court proceedings:

It is not so much about conduct as state of mind. The issue is no longer whether the employer fired the plaintiff for "just cause," whatever that might now mean in a world of "employment at will." What the plaintiff must do is show that the employer acted to harm him.

....In post-union America, this is the legal system we now have. It forces us to cast legal issues in the most subjectively explosive way, i.e., "racism," "sexism," to get around the fact that we no longer can deal objectively with "just cause." Do I regret I am part of it? Yes. Are my clients often full of hatred? Yes.

In the same way that financialization has a corrosive impact on a country's economy and its ability to produce useful goods and services, you might call this the judicialization of governance, which erodes our country's ability to produce useful, broad-based, widely accepted policy. The best evidence of this is also the most obvious: Over the past few decades, we've gotten to a point where more hostility and bitterness are expended over the appointment of judges than over virtually any other legislative or executive priority.

As for Fukuyama's "vetocracy," that's a sore point of longstanding, and one that's become worse and worse over the past decade. Fukuyama puts it this way:

The United States is trapped in a bad equilibrium. Because Americans historically distrust the government, they aren’t typically willing to delegate authority to it. Instead, as we have seen, Congress mandates complex rules that reduce government autonomy and render decisions slow and expensive. The government then performs poorly, which perversely confirms the original distrust of government. Under these circumstances, most Americans are reluctant to pay higher taxes, which they fear the government will simply waste. But while resources are not the only, or even the main, source of government inefficiency, without them the government cannot hope to function properly. Hence distrust of government becomes a self-fulfilling prophecy.

The whole essay is worth a read. And I congratulate Fukuyama for not even pretending to write a final paragraph with potential solutions. Instead, his final line is, "So we have a problem." Indeed we do.

Chart of the Day: Obamacare Enrollment Up Sharply on Federal Exchange

| Wed Dec. 11, 2013 12:13 PM EST

The latest HHS report on Obamacare is out, and by interpolating the data on page 3 we can figure out how many people who have successfully selected a health care plan via the federal website since it opened in October. Here are the approximate numbers for signups per week:

Not bad. There was a big jump at the end of November, and continued growth in the Thanksgiving/Black Friday week after that. That said, these numbers still need to grow substantially. At this point in the game, the enrollment rate needs to start pushing 200,000 per week or so on the federal exchange in order to meet the overall enrollment goals set for March of next year. There's still lots of work ahead.

Support for a $10 Minimum Wage Is Surprisingly High

| Wed Dec. 11, 2013 2:18 AM EST

I'm not super interested in the latest poll results about whether Obama's approval is up or down a point or two, or whether Obamacare is up or down a point or two. It'll all shake out soon enough. But the Wall Street Journal's latest poll asked about raising the minimum wage, and the results were pretty interesting:

So 63 percent were in favor of raising the minimum wage to $10.10. That's surprisingly high. Hell, 43 percent even favor raising it to $12.50. I don't imagine that this support is especially deep or passionate, but it's still pretty high. As Damon Silvers of the AFL-CIO says, "If I was a House Republican, I'd be concerned about opposing anything that polled at 63%."

Of course, gun registration polls at better than 63 percent, and so do higher taxes on the rich, just to name a couple of examples. That doesn't seem to have caused very many Republicans to start quaking in their boots. Still, it's encouraging news.