Relevant and even prescient commentary on news, politics and the economy.

Joe Biden: “How Are We to Pay for Single Payer Healthcare Alias Medicare for All?”

Joe knows the answer to this question and he is baiting the other candidates. Joe has a history of supporting big business interests as witnessed by his aggressive support of the banking industry with bankruptcy laws favoring banking against the needs of citizens and with a special intended harshness when it comes to student loans. Joe has sponsored or cosponsored every bankruptcy bill since 1997. With his question and his healthcare bill, I believe Joe  is courting the healthcare industry and the healthcare insurance industry’s support. Other candidates need to call Joe out on this.

Before moving to Medicare4All or a form of it, we need to attack the costs of healthcare which are rising at a clip greater than inflation.

Much of the payment for improved healthcare will come from negotiating with pharmaceutical companies, reducing the increasing cost of hospital inpatient and outpatient care, rolling back unnecessary pricing increases, reducing costs to 120% of Medicare costs today, etc. There are enough cost targets to attack which should provide a wealth of lower costs and funding for expansion. Healthcare Cost Drivers Pharma, Doctors, and Hospitals

Kocher and Berwick gave an outstanding recital of how we will get from Medicare and Commercial Insurance to just Single Payer Medicare4All. “While Considering Medicare For All: Policies For Making Health Care In The United States Better.” It is unlikely, Congress will move on Medicare4All in the beginning. It will take time. Today’s Medicare is not free from issues.

As the Director of Medicare and Medicaid and upon departing the position, Donald Berwick made this observation of today’s Medicare:

“20 to 30 percent of health spending is ‘waste’ that yields no benefit to patients, and that some of the needless spending is a result of onerous, archaic regulations enforced by Medicare and Medicaid.

He listed five reasons for what he described as the ‘extremely high level of waste.’ They are overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud.

Much is done that does not help patients at all and many physicians know it.”

Within the PPACA, the issues with ACOs must be fixed. The initial PPACA ACO strategy has given hospitals the ability to exploit the market through consolidation, eliminating or minimizing competition in regions, leading to increased pricing, and enabling the employment of specialist doctors, making them “must haves” in insurance networks. As planned, the ACOs should have generated administrative cost synergy and quality benefits instead of enabling ACOs to consolidate and control prices.

Single payer does not use ACOs. In single payer, the government will pay hospitals, healthcare professionals, pharmaceutical and healthcare supply companies. The government will also set the budgets for hospitals and healthcare. Single Payer in Vermont was going to fail and failed due to cost because it used 3 ACOs to manage its plan. Bernie Sanders is also using ACOs in his plan. “Why the Bernie Sanders Bill Is Not Single Payer” The only fear I have of this type of arrangement is the influence of the healthcare industry on those determining pricing and accepting costs. The healthcare industry is attempting to establish a methodology using value brought to the patient clinically and in quality of life with resulting benefits to the health-care system and society also. It is an argument on the issue of the morality of higher prices. Single Payer will have to contend with this as much of the pricing argument is not justified.

The plan should be to gradually move from insurance administered healthcare (what Kocher and Berwick propose) to a single payer system similar to what Sanders proposes but minus ACOs. As I explained, there are enough cost targets to pay for much of the implementation to be derived from reducing costs in the present healthcare system.

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Whither Ukraine?

Whither Ukraine?

Or “wither Ukraine?” some might suggest?  But no, after nearly 30 years of serious economic stagnation and massive corruption, along with losing territory to neighboring Russia with whom it has on ongoing military conflict, things are looking up there.  GDP grew at 4 percent annually last quarter.  The  hryvnia currency has been the second most rapidly rising currency in the world during 2019.  There has even been a prisoner exchange with Russia.  All this comes under its new president, Volodymyr Zelensky, who until recently was playing a Ukrainian president on a TV show. That sounds like a joke, but so far he seems to be delivering the goods, including an apparent effort to combat the deeply entrenched corruption practiced by both his pro-Russian and pro-EU predecessors.

A curious aspect of this so far successful presidency seems to be the effort by President Trump to undermine it, or at least not help it.  $250 million in military aid has been canceled.  Is this more payoff to Vladimir Putin for a future Trump Tower in Moscow?  There have also been reported efforts led by Rudi Giuliani to get the Ukrainian government to open an investigation into alleged misdeeds by a son of Joe  Biden who worked for a Ukrainian company for awhile. There have also been efforts to get them to denny charges made against former Trump campaign manager, Paul Manafort.  Rumors are that the military aid is being held up until The Ukrainians deliver on the firrst of these items, which would be pathetic.  So far they do not seem to be going along.

I was in Kyiv (Kiev) last weekk for a nonlinear economic dynamics conference and can confirm that the optimistic feelings are shared by Ukrainian economists I met there, some of whom I have known for a long time and who have not been like this in the past.  Maybe it will not work out, but for now there definitely is optimism there. Ironically an advantage of not having had much economic growrth over the last 30 years is that there are few modern glass and steel buildings downtown, with many very beautiful per-revolutionary ones there, with sculptures on them and painted bright colors.  This goes along with various historical buildings and sites dating back nearly a 1000 years.

Barkley Rosser

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F**king Old Enough to Vote

It’s That Day again. I mostly stayed off Facebook (except for birthday greetings) and Twitter, but even LinkedIn has posts of now-yellowed newspaper articles of survivors–and probably some of those who didn’t.

In another ten years, it will be as far from 11 Sep 2001 as that date was from 11 Sep 1973.

At least now, most people know what a sh*t Rudy Giuliani was, both in setting up the firefighters for disaster and moving the NYC Office of Emergency Management Command Center from the safest location in the city–the basement of 1 Police Plaza–to the 23rd floor of a building in a complex that had already been bombed once before he did it. While he and Bernard Kerik got to Be Adulterers on taxpayer money, somewhere between one-third and one-half of the 343 firefighters they murdered outright certainly could have been saved. Though that would have been more people who, but for the grace (and anger) of Jon Stewart, would still be trying to get health care. Rudy’s tombstone should read: ““This group’s finding is that the security of the proposed O.E.M. Command Center cannot be reasonably guaranteed” — July 1998″

Yes, I’m still bitter. No, I’m not going to post anything nearly as subtle as this, which is probably my ultimate contribution to the genre of In The Shadow of The Towers. I’m going to talk about Milton Friedman. Because it’s the 18th anniversary, so it’s now old enough to vote–or, especially in the pre-26th Amendment world–be drafted.

Let’s be clear: Milton Friedman had one good idea in his life, and that was that his alma mater should not sponsor a football team. Even a broken clock, and the program whose highlights are Ray Rice and Greg Schiano (whose skills included guiding the team to a money-losing Bowl appearance) isn’t exactly something that could justify Superstar Economics Theory.

Milton Friedman, like Gary Becker, was wrong about almost every social policy recommendation he made. While it might be difficult to identify what he was most wrong about, a leading contender is The Elimination of the Draft, which he championed for years and finally shepherded through the Nixon Administration.

After all, people should be Free to Starve Choose, and conscription is certainly not a “choice.” Choice can discriminate; conscription means mandatory attendance or a demonstrable reason to be excused. Friedman’s ghost, twirling at Mach 3 in the Eighth Circle, probably rues that males still must register for Selective Service.

So we have a story published just over two years ago on America’s only remaining news source becoming evermore real. While before people who didn’t want to be subject to two years of training and possibly warfare had to at least come up with a somewhat reasonable excuse (*cough* bone spurs *cough*) or face jail time, the scions of the elite have no “skin in the game.” So the Longest War in U.S. History continues: planned as well as it was executed, executed as well as its objectives were planned. While the planners well know that their sons (and daughters) will not even have to come up with the lies they did to avoid any chance of being killed.

Because Milton Friedman said that would not be Freedom. And people believed him, because “freedom” means you don’t have to “have skin in the game” (literally, in this case) if you don’t want to, even if your actions caused the problem.

I suspect Rudy Giuliani approves.

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MbS Consolidates Immediate Family Control Of Saudi Oil Industry

MbS Consolidates Immediate Family Control Of Saudi Oil Industry

Saudi Oil Minister al Falih, who also ran ARAMCO, has been replaced by Abdulaziz bin Salman bin Abdulaziz  al Sa’ud, half brother of Crown Prince Mohammed bin Salman bin Abdulaziz al Sa’ud, (MbS),who was Ambassodor to the US untile the Khahoggi murder got hot between USA and KSA.

The New York Times claims that this is part of an effort by MbS to modernize the Saudi economy, an ongoing line of th Saudi PR machine.  However more specifically how al Falih got in trouble with MbS is that oil prices are too low and there has not yet been an IPO for ARAMCO.  These probably are issues for MbS, although I think at this point the Saudi Oil Minister’s ability to make oil prices go up has become limited.  But the lack of an ARAMCO IPO clearly has cost variouis members of the Saudi royal family money.  But the problem has been that to issue an IPO ARAMCO will have to make public information that apparently it does not want to.  Whether MbS and his brother are really ready to do that is unclear.

Anyway, I think all this talk about modernizing is just baloney.  This is just a further move to consolidate power and also make money for the Salmans, the king and his sons.

Barkley Rossser

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I get Ruthless With David Leonard

(Dan here…lifted from Robert’s Stochastic Thoughts)

by Robert Waldmann

I get Ruthless With David Leonard

David Leonard picks cherries in a generally good op-ed. I agree entirely with his general conclusion that Democrats should run a populist campaign (no triangulation — he should have noted that Clinton ran on raising taxes on the rich and cutting taxes on the middle class in 1992 — he was a populist before he was a triangulator). He also says don’t talk about decriminalizing border crossing or eliminating private health insurance. I agree entirely. He relies on a Pew poll on issues. It is an interesting poll by a good pollster.

However, I think there should be a rule that any commentary on polls should consider all available still relevant polls. The norm of non data journalists writing about data is still to comment on one poll. This is nonsense. It is like election night coverage based on an interview with one voter. There is, I think, no excuse for looking at data other than averages of polls. I think fivethirtyeight.com can improve on the simple average, but that’s not my current assertion. I am asserting that any commentatory must justify (to an editor not the readers) every decision to not consider every poll which is not considered.

I was triggered by this passage justified by three picked cherries.

Yet Democrats are frittering away their advantage — and damaging their image. Last fall, most Americans had a favorable view of the Democratic Party, according to the Pew Research Center. That makes sense, because Democrats ran a populist campaign in the 2018 midterms, focused on pocketbook issues that dominate many people’s lives, like wages and medical costs.This year, the polling has flipped. Most Americans now have an unfavorable view of the party, no better than their view of the Republican Party. Likewise, slightly more voters say the “ideas being offered by the Democratic candidates” would hurt the country than say would help, according to the NPR poll.

 

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Decennial Census Temp & Intermittent Employment

There seems to be some confusion about the impact of Census employment of temporary and intermittent employment for the 2020 Census.

The U.S. Bureau of Labor Statistics has a table showing the monthly  employment for Special Census workers. You can find it at: BLS – Special Census Workers

The table also has the data from the 1990 and 2000 Census so you can compare what happened in those Censuses to what to expect over the next year. I took the data from Table 1 of total nonfarm employment and subtract the Census employment to create  a new series,  Total NonFarm Employment excluding Census Temp & Intermittent Employment.  The chart shows the last some 20 years of  special Census employment.  As you can see, this months 27,000 increase hardly shows in the chart compared to what happened in the 2000 and 2010 Censuses or what we can expect over the next year.

 

 

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Trump: When Reality TV Becomes Reality

Trump: When Reality TV Becomes Reality

The New York Times has an excellent dissection today of the Trump presidency as a reality TV show that has managed to set up shop at 1600 Pennsylvania Avenue, written by its chief TV critic, James Poniewozik.  His op-ed digs down into the props and story line of “The Apprentice” and how its tone evolved over its 14-year lifespan.  He places it nicely within the ecosystem of post-Survivor entertainment and the particular celebrity culture it spawned.  Nice job, and read it for yourself.

But there’s something missing.  Yes, that’s who Trump is and how he operates, but he could never have gotten to where he is without cutting deals with people whose personas are light years away from his—the plutocracy, particularly in its financial and resource extraction modes, the Republican Party apparatus in the think tanks and lobby shops in and around Washington, and the Christian Right, with its fixation on the courts as a bulwark against cultural change.  There is a real, which is to say a real real, side to the Trump presidency, and it takes the form of tax cuts, regulatory rollbacks and judgeship appointments.  This differentiates it from reality TV, which is only itself.

And so we are left with an obvious response: stop rebroadcasting the reality TV stuff.  Leave it alone.  Don’t fixate on the bluster, viciousness, racism or obscenity of his tweets and rallies.  Rather, examine the real real viciousness, racism and obscenity built into the policies of the people who use Trump as an avatar, an attention-grabbing figurehead who enables them to hold and use power.  Yes, I’ve said this before, but it’s still the way to go.

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A Striking Fact Reported in the August 28 2019 Quinnipiac Poll

Voters who are paying a lot of attention to the race are much more to support Elisabeth Warren than voters who are paying little or no attention. It is also true that voters who are paying a lot of attention are more likely to support Joe Biden than Elisabeth Warren. Finally, Voters who are paying a lot of attention are somewhat less likely to support Bernie Sanders than are voters who are paying little or none.

If you don’t see an image cut and pasted from Quinnipiac click on the “Read More >” link at the bottom right corner of the post to see the image of the polling results.

The whole pdf report of the results is here

6% of people who are paying little or no attention support Warren and 25% of people who are paying a lot of attention support Warren. In contrast the numbers are almost identical for Biden who has 31% among those paying little or no attention and 32% support among those paying a lot of attention. Finally Sanders has 18 % support among those paying little or no attention and 11% support among those paying a lot of attention.

I think this is interesting. For one thing, people pay increasing attention as time passes. This helps explain the striking increase in overall support for Warren. I would tend to suspect that support for Warren will continue to increase.

But it might just show that nerds like nerds, that people who claim they have paid a lot of attention like the candidate who always has a plan for that. If this explains the pattern, there is less reason to forecast continued increase of support for Warren. People pay more attention to elections as the voting day approaches, but non nerds do not become nerds.

Anyway, I thought the polling data is interesting.

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Does O’Rourke Have The Trade Strategy For Dems Against Trump?

Does O’Rourke Have The Trade Strategy For Dems Against Trump?

I have been posting here periodically on how it seems that the Dems do not seem to have a strong or well-defined position about Trump’s trade wars that seem politically effective or even coherent.  The few candidates who have made noise about essentially returning to Obama’s policy, e.g. Hickenlooper, have done so poorly they are dropping out or at least not in the 10 making the next debate stage.

We then have those who think what is called for is being “tougher than Trump on trade,” with Bernie Sanders literally saying that.  Warren has a more nuanced version of that, but which amounts to calling for renegotiating essentially all US trade agreements to make them more labor and environmentally friendly.  Maybe on the eve of Labor Day I should jump up and  down for that, but frankly, it looks about as wise as Cory Booker joining Trump in calling for the JCPOA Iran nuclear deal to be renegotiated, in other words, not so wise although it make look good as a campaign slogan.

Most of the others seem to be avoiding the topic, apparently aware that different groups in the Dem party have quite different views about this.  It is not an easy issue, although increasingly it looks like one where Trump is becoming increasingly unpopular, with this likely to get very serious if the economy seriously slows down with Trump’s trade wars getting a lot of the blame.

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