Tyler Cowen has a question:

In the United States, Medicare starts at age 65. So to the extent health care improves health outcomes, we should see a noticeable uptick in results as people reach 65, at least relative to the trajectory of aging they otherwise would experience. Of course many other national health care systems treat 64 and 65-year olds as the same, so we can compare the American case to those alternatives. That would give us a better sense of the relative performance of single-payer coverage, no?

Most people in the US have health coverage, so turning 65 and qualifying for Medicare doesn’t really change anything for them. Among those who don’t have coverage, I think there have been a few studies making use of the discontinuity at age 65, but I don’t remember what they concluded. I wouldn’t expect anything very dramatic, though. After a lifetime of poor health coverage, suddenly getting good health care at age 65 is unlikely to have any kind of immediate impact.

But that doesn’t interest me too much. Mainly, I’m posting about this because I think it asks the wrong question. Unfortunately, it’s a very, very common question.

For the most part, there’s no special reason to think single-payer health care produces substantially different outcomes from the US system. Most people in the US get good health care, and most people in France get good health care. We’re better at some things, they’re better at other things. Beyond that, “overall health outcomes” is such a fuzzy concept that it’s all but impossible to measure, and mortality rates are hopeless as a metric. There are just too many variables aside from health care that contribute to it. Life expectancy owes more to poverty rates, public health measures, and cultural norms (around eating habits, cigarette smoking, etc.) than it does to acute health care.

The right question to be asking is: What kind of system is most efficient? The advantages of single-payer are that (a) it leads to lower costs, (b) it’s far more convenient, and (c) it covers everyone. The advantages of the US system are—something. I’m not sure what, to be honest. I suppose some people would argue that the higher prices we pay effectively fund most of the world’s advances in health care, while everyone else is free riding on our backs. There’s probably a kernel of truth to that, but I’ve never seen any persuasive evidence that it’s much more than that.

In any case, the question to ponder is how France (and every other advanced economy) can provide high-quality health care that covers 100 percent of their residents for about a third less than we pay to cover 90 percent of ours. Isn’t market-based health care supposed to lead to lower prices, not higher?

Where was I on Wednesday, anyway? I will give you a hint:

From the LA Times:

Anthony Scaramucci, announced little more than a week ago as President Trump’s White House communications director, was ousted Monday before he was even officially sworn in. John Kelly, the newly appointed chief of staff, told Scaramucci he was going to be replaced around 9:30 a.m., according to a person close to the White House.

Oh come on. The only way this gets better is if they bring back Sean Spicer and promote him into Scaramucci’s position.

Will Donald Trump sabotage Obamacare by cutting off CSR subsidies for low-income workers?

A pair of prominent lawmakers urged President Trump on Sunday not to sabotage the Affordable Care Act, or Obamacare, in the wake of failed Republican efforts to scrap his predecessor’s signature legislative achievement.

….Sen. Susan Collins, the Maine Republican who steadfastly rejected a series of GOP healthcare measures last week, blamed the Trump administration for encouraging instability in the insurance markets….“I’m troubled by the uncertainty that has been created by the administration,” Collins said on NBC’s “Meet the Press.” She contested Trump’s characterization of the payments as an “insurance company bailout.”

“That’s not what it is,” she said, calling the reduction payments “vital assistance” to low-income Americans.

I’ve given up trying to predict what Trump will do. I can think of a dozen ideas that might flow through that squirrelly head of his on both sides of this question.

However, the Washington Post’s Amber Phillips has more courage—or foolhardiness—than me. Of four possible avenues for Republicans to take on health care, she ranks sabotage last. She ranks this as the most likely outcome:

Republicans start working with Democrats to make tweaks to Obamacare.

Surprise! The most likely option to revive Obamacare repeal isn’t to repeal it at all.

Republicans tried for months on their own, couldn’t do it, and now some key GOP lawmakers are advocating for the opposite approach….There’s a growing consensus among GOP members of Congress that working within the confines of Obamacare may be the only way to fix what they see as wrong with the law.

That’s a brave prediction, and I sure wouldn’t bet the ranch on it. That’s not because it doesn’t have some appeal. It plainly does. For one thing, a genuine compromise could get 60 votes, which means anything is fair game. You don’t have to worry about following all the arcane rules of reconciliation bills.

Nonetheless, it’s hard to see it happening. The Democratic asks are fairly easy to figure:

• First, leave everything alone. Fund the CSR subsidies, enforce the individual mandate, don’t kill the taxes, etc.
• Maybe reduce the max percentages families have to pay for health coverage at working-class incomes (for example, at 250 percent of the poverty level, make the cap 5 percent of income instead of 8 percent). Maybe create a high-risk reinsurance pool for extremely high-cost patients. Maybe a Medicaid buy-in for anyone who wants it.

It’s unlikely Republicans would agree to any of this, but if they did what could they ask for that wouldn’t be a deal-breaker for Democrats?

• Change the age band to 5:1.
• Some kind of cheap catastrophic coverage for the young.
• Higher funding for HSAs.
• Ease the rules for Medicaid experimentation by the states.

There’s more like that, but it seems unlikely to appeal to very many Republicans. What they really want is (a) lower taxes, (b) lower Medicaid spending, and (c) an end to the individual mandate. I suppose Democrats might agree to very modest versions of A and B, but certainly not C, which is vital to a functioning marketplace.

I dunno. It’s hard to see any kind of deal here, especially with Mitch McConnell so pissed off and Paul Ryan still under the spell of repealing everything. But I guess you never know.

The LA-San Francisco bullet train got hit with another setback last week:

California’s high-speed train project is likely to continue to be buffeted by environmental challenges as a result of a decision by the state’s top court. In a 6-1 ruling last week written by Chief Justice Tani Cantil-Sakauye, the California Supreme Court decided that federal rail law does not usurp California’s tough environmental regulation for state-owned rail projects.

This is a win-win-for me. I happen to think the bullet train is a bad idea, so anything that slows it down and leads to its possible demise is fine with me.

Alternatively, maybe this will light a fire under Jerry Brown to do something about California’s regulatory environment. It’s not that I think our environmental rules are necessarily too harsh, only that they’re incomprehensible and ungodly slow. One way or another, environmental regs at various levels of government—city, county, state, water district, coastal commission, etc.—need to be streamlined and made less ambiguous. It should be possible to enforce strict standards, but at the same time (a) make it clearer precisely what those standards are, (b) restrict the number of lawsuits over new projects, and (c) give courts the tools to rule more quickly on the lawsuits that remain. It shouldn’t take ten years just to get approval to build a high-rise in central Los Angeles. Either approve it or deny it, but don’t take forever to do it.

Tyler Cowen points me today to a new Census Bureau report that suggests the elderly are better off than we think. Why? Because when they respond to surveys, they don’t accurately report pension income:

The Current Population Survey Annual Social and Economic Supplement (CPS ASEC) is the source of the nation’s official household income and poverty statistics. In 2012, the CPS ASEC showed that median household income was $33,800 for householders aged 65 and over and the poverty rate was 9.1 percent for persons aged 65 and over. When we instead use an extensive array of administrative income records linked to the same CPS ASEC sample, we find that median household income was $44,400 (30 percent higher) and the poverty rate was just 6.9 percent….The discrepancy is mainly attributable to underreporting of retirement income from defined benefit pensions and retirement account withdrawals.

Here’s the key pair of charts for people 65 years and older:

It’s surprising how hard it is to get data on pension income in particular and the income of the elderly in general. For past years, the data often just doesn’t exist, and for more recent years the data is full of problems. However, this study doesn’t surprise me. After spending a lot of time diving into what data exists, I’ve come to the conclusion that, in general, the elderly are (a) better off than we think and (b) have seen their income rise considerably more than any other age group over the past couple of decades. More details here.

The poorest elderly—primarily folks who spent their working lives at low-income jobs and now rely solely on Social Security—are truly in need, and their Social Security payments ought to be increased by a third or so. We also ought to do something about long-term nursing care, which can quickly bankrupt even the well-off elderly.

Those two things are what progressives should focus on, not on the mythical “retirement crisis.”

Austin Frakt posted an old New York Times chart of personal expenditures, and a reader has a question:

Tweeps? https://t.co/lXMdkokchj

— Austin Frakt (@afrakt) July 31, 2017

The answer, as it is so often, is FRED, the economic data aggregator from the St. Louis Fed. Here it is:

When I use data from FRED, I always include it as a source. Why? Because it’s a great service, and deserves to get more credit. They don’t cover literally everything—for some reason, the Census Bureau doesn’t share its data, for example—but they cover a helluva lot. And once you learn how to use it, you have fast, convenient access to data from dozens of agencies. I probably could have dug up this chart over at the BEA, but it would have taken me a while. FRED made it the work of a few minutes.

Shawn Thew/CNP via ZUMA

Ezra Klein notes this morning that President Trump has turned on some of the people who were among his earliest and staunchest supporters:

Attorney General Sessions was one of Trump’s earliest, staunchest supporters. On the night Trump won the election, he singled out Sessions for special praise. He thanked Sessions for being “the first man, first senator, first major, major politician” to endorse him, going on to say Sessions was “highly respected in Washington because he’s as smart as you get.”

….During the campaign, Priebus was among Trump’s most consequential allies….No matter what Trump said, or what Trump did, Priebus kept the RNC in his corner, and, once Trump had won the nomination, turned it into the campaign machinery Trump had never bothered to build.

I don’t think this is just a coincidence. I’m averse to grand theories of Trump, but two things that are obvious about him are (a) he’s ultrasensitive about how narrow his victory was and (b) he doesn’t like to share credit with others. James Comey was a daily reminder that a lot of people think Trump won only because Comey’s last-minute letter sank Hillary Clinton, so Comey had to go. A lot of people credit Reince Priebus with keeping Trump viable during the primaries, so Priebus had to go. A lot of people think Jeff Sessions was instrumental in bringing evangelical support on board early in the campaign, so Sessions has to go. Trump hasn’t yet fired Steve Bannon, a guy who gets a lot of credit for turning around the Trump campaign during the summer, but I wouldn’t be surprised if he does eventually. This is probably one reason that Bannon keeps such a low profile. The last thing he wants is more magazine covers praising him as “Trump’s Svengali” or somesuch.

Back in his real estate days, Trump’s staff was essentially invisible—and nobody cared about them anyway. Trump never had to share credit with anyone. But Washington plays by different rules, and that drives Trump crazy. There’s not much he can do about it except to fire anyone who helped him win, so that’s what he’s doing.

From the Wall Street Journal:

U.S. Companies Post Profit Growth Not Seen in Six Years

America’s largest companies are on pace to post two consecutive quarters of double-digit profit growth for the first time since 2011….Earnings at S&P 500 companies are expected to rise 11% in the second quarter, according to data from Thomson Reuters, following a 15% increase in the first quarter.

That sounds great! So does that mean worker pay has also posted strong growth? Let’s take a look:

I’ve used the employment cost index, which accounts for things like health care and other benefits, not just wages. And since corporate profits were down in 2015-16, I’ve used two-year growth rates, adjusted for inflation, to get a fair reading of longer-term earnings vs. pay.

As you can see, employee compensation growth roughly matched corporate profit growth in 2016, but in the first half of 2017 corporate profits have spiked while wage growth has been meager. Basically, corporations have manufactured profits by being stingy with workers.

I’m certainly happy to see businesses doing well. But I’d be a lot happier if this meant that workers were doing well too.

There is so much going on in this photo….Corey, Scaramucci, Gorka, and Omarosa….. pic.twitter.com/qlvLfbOXHp

— Yashar Ali (@yashar) July 30, 2017