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The Wrongologist

Geopolitics, Power and Political Economy

Saturday Soother – June 27, 2020

The Daily Escape:

Mt. Rainer from the Whiteriver campground – 2020  photo by np2fast

Good morning fellow disease vectors!

Now that Florida and Texas have again closed their bars, you’re probably wondering: “Can Joe Biden’s lead in the polls get any bigger”?

Here’s your answer. On Thursday, the Trump administration asked the Supreme Court to invalidate the Affordable Care Act. They did this without any plan for replacing it, at what appears to be the height of new cases of the COVID pandemic. From Charlie Pierce:

“Imagine, for a moment, you’re a Republican. You already know that your party has hitched its wagon to the biggest ass in the history of American politics, and that he has proceeded to bungle a response to the worst public health crisis in a century, touching off a deep recession in the bargain….Perhaps you’re thinking to yourself this morning, y’know, maybe this isn’t the best historical moment to take healthcare away from tens of millions of Americans.”

Political gurus say that timing is everything.

Trump is doing this despite the fact that 487,000 new people signed up with HealthCare.gov last month after losing their company-provided health insurance coverage because of the pandemic-induced recession. That was an increase of 46% in sign-ups compared to the same month last year.

And Trump’s trying this stunt in the week when the US hit a new record for the highest daily total of reported COVID-19 cases – more than 45,500! He’s picked the perfect time to try again to throw an estimated 20 million Americans off of their insurance coverage.

This has been the GOP plan all along: we’re trimming the rolls of people on entitlement programs. We’re doing it through the courts, through legislation and by allowing the COVID-19 infection to spread.

It’s no longer clear which is the greater threat to lives in America: The Coronavirus, or Donald Trump.

This should remind all of us that we need to make Medicare for All, or another form of single payer insurance, a top priority after the November election.

Biden said it all in a speech this week: (brackets by Wrongo)

“Amazingly, he [Trump] still hasn’t grasped the most basic fact of this [COVID] crisis: to fix the economy we have to get control over the virus. He’s like a child who can’t believe this has happened to him. All his whining & self-pity…his job is to do something about it.”

We desperately need new leadership. Maybe we’ll get it next January.

Now it’s time to forget the Sahara Dust storm for a few minutes. You should also ignore the fact that the Dixie Chicks changed their name to “The Chicks”. How exactly does THAT rebranding improve our world, or their career?

Time to take our masks off, sit at an appropriate physical distance, and kick back: It’s time for our Saturday Soother.

Let’s start by brewing up a huge mug of Ethiopia Nano Genji Agaro Gera coffee ($21.00/12oz.) from Sacramento CA’s Temple Coffee roasters. The roaster says you will experience notes of nectarine and apricot with your first sip.

Now find a comfortable lawn chair, and settle in to listen to “Summertime”, written by George and Ira Gershwin, and Dubose Edwin Heyward, in 1935. It’s performed here by George Winston from his album “Restless Wind”:

It was also memorably performed by the late, great Sam Cooke in 1957, released as the B-side on the single of Cooke’s big hit, “You Send Me”.

Those who read the Wrongologist in email can view the video here.

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American Exceptionalism Doesn’t Include Your Healthcare

The Republican’s effort to repeal and (maybe) replace the Affordable Care Act (ACA) began today. From NPR:

Opening punches were thrown in what one top Democrat today called “the first big fight” of the new congressional year — the promise by President-elect Donald Trump and GOP lawmakers to repeal and replace the Affordable Care Act.

The Obamacare debate is political and ideological, and it obscures a hard truth about healthcare in America. Historically, we spend more money than any other country on healthcare.

In the late 1990s, the US spent roughly 13% of its GDP on healthcare, compared to about a 9.5% average for all high income countries. However, the difference has steadily increased. Last year, as the ACA continued to roll out, healthcare costs hit 17.5% of GDP, the highest ever. That’s $9,695 per person.

We spend over $3 trillion on healthcare annually, and that rate of spending is expected to accelerate over the next decade. With all the debate about Obamacare, and what should replace it if it is repealed, we are ignoring what healthcare costs in the US, relative to other high income countries. It may surprise you that America doesn’t have better care than other high income countries, if we compare life expectancy to per capita health expenditures:

Source: Visual Capitalist

Americans spend more money, but do not receive similar results to other countries using the basic metric of life expectancy. The chart shows that the divergence started before 1980, and it widens all the way to 2014. While the 2015 statistics are not plotted on this chart, but we know that the healthcare expense in 2015 was 17.5% of GDP, so the divergence is likely to continue to widen.

The conclusion is that while our healthcare spending is considerably higher than in other high income countries, it’s also relatively less effective. If America spent more money and got the same results, we might say that our system is unique, but it produces similar outcomes, so let’s keep it the way it is.

But in fact, Americans on average live shorter lives than people in other high income countries. In fact, life expectancy went down in 2015:

The overall death rate for Americans increased because mortality from heart disease and stroke increased after declining for years. Deaths were also up from Alzheimer’s disease, respiratory disease, kidney disease and diabetes. More Americans also died from unintentional injuries and suicide.

We have a broken political system, one that cannot deal with the root cause of our expensive healthcare, or the fact that our healthcare system simply doesn’t produce the results that others can.

Despite the talk by Republicans about Obamacare being socialized medicine, our system is private, with the exception of the health insurance provided by Medicare and Medicaid. Our insurance companies are private, our physicians and providers are private.

By some estimates, the private multi-payer system in the US adds $0.38 for every dollar spent to cover the profits and the discreet management organizations that exist in our multi-payer system. The problem is that there is so much money (over $1 trillion) going to the private players, that they will fight like hell to keep the system as it is.

And they have the lobbying funds available to fight to keep the status quo. Thus, we will continue to deal with excessive costs regardless of no Obamacare, or some jury-rigged GOP Obamacare replacement.

In our Exceptional system, the fact is that even though you pay for health insurance, you are not the actual customer. When you go to the doctor or to the hospital, you are not the actual customer. The Insurance companies are the true customers of the doctors and the hospitals, and for the insurance companies, their shareholders are the true customers.

And before you question the statistics, saying for example, that the US counts infant deaths differently than they do in other countries, the infant death rate in the US is about 0.5% of births, and with about 4 million births in the US that translates into about 20,000 infant deaths. If you remove 20,000 people assigning them a life span of zero, in a country of 320 million people, the overall average life expectancy rises by only 1.81 days (43.4 hours). That is the statistical life span increase assuming we had zero infant deaths. (Please check Wrongo’s math).

Higher infant death rates have virtually no effect on the results shown on the chart.

Remember: Whomever is getting that extra $1 Trillion dollars every year has a trillion reasons why they should keep getting it.

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Moving the Goal Posts on Obamacare

Gallup has an informative chart about the declining percentage of uninsured in the US:

Gallup on ACA

The percentage of uninsured Americans climbed from the mid-14% range in early 2008 and peaked at 18.0% in the third quarter of 2013. The uninsured rate has dropped sharply since Obamacare (the Affordable Care Act) took effect at the beginning of 2014.

It is possible to argue that an improving economy and a falling unemployment rate may have accelerated the steep drop in the percentage of uninsured over the past year. However, the uninsured rate is significantly lower than it was in early 2008, before the Great Recession, suggesting that the recent decline is due more to Obamacare than to just an improving economy.

From NY Magazine on this trend:

It is starting to look possible that this trend is not some random fluke that has happened six straight quarters but is somehow related to the enactment of Obamacare. So any day now, we can expect conservative politicians and intellectuals to begin publicly rethinking their analysis of this law.

They were correct. Here is the 2010-2014 short version of the Republican viewpoint on the ACA:

The ACA will not reduce the number of people without health insurance. Indeed, it might make this problem we don’t consider a problem, even worse.

Now that the ACA looks to be doing the job, the 2015 short version of the Republican viewpoint is:

Everyone knew that the ACA would result in a huge drop in the number of people without health insurance — what does that prove? Besides, how can we really know that it all isn’t a big coincidence?

This is called “Moving the Goal Posts”. Wikipedia says it means

To change the criterion (goal) of a process or competition while still in progress, in such a way that the new goal offers one side an intentional advantage or disadvantage.

Here is an example of moving the goal posts. From Cliff Asness: (emphasis by the Wrongologist)

In contrast, the rise in coverage is heralded by a myriad of Obamacare supporters as one of two major pieces of proof the law is working. But, how can something we knew before the fact be proof of anything?

Shorter: If we predict that something good will happen as a result of a new law, and that good thing happens, it doesn’t count as proof that the law served its purpose or was any good at all, unless Republicans say so.

The goal post movers also said Obamacare was a job killer. House Speaker John Boehner announced on March 17, 2010, five days before President Obama signed the ACA into law:

The President … continues to push his job-killing government takeover of health care that will hurt small businesses at a time when they need certainty, not more Washington tax hikes and mandates.

In 2011, House Republicans even passed the “Repealing the Job-Killing Health Care Law Act” — the first time that any piece of congressional legislation ever had “job-killing” in its title. Sadly for both Mr. Boehner and the House Republicans, we have added 12 million new private sector jobs since the bill was passed.

There is a new J.D. Power survey which looks at enrollee satisfaction with the ACA. It finds that people who signed up for insurance on the exchanges were slightly more satisfied (69.6%) than people with non-exchange plans, usually through employers (67.9%). People re-enrolling on the exchanges were 74.4% satisfied. New enrollees for 2015 were 5.5% more satisfied than 2014 enrollees, who endured the disastrous roll-out of healthcare.gov. So people like the subsidies and they like their actual insurance policies.

Think about it: ACA forecasted costs have been consistently revised downwards. The number of uninsured are dramatically lower. Satisfaction with Obamacare is higher, and it didn’t kill jobs.

It’s utter Tyranny.

Maybe that’s why the Senate’s top five Republican leaders have cosponsored legislation to extend Obamacare insurance subsidies until 2017. The extension will give Republicans more time to again move the goal posts.

They should try this one: Now that Republicans control Congress and most state governments, we have way fewer uninsured.

Conservative policies work!

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