Another Dave Is Gone

Bill,

The Times just posted Dave Brubeck's obit. He was the 1st jazz musician I ever heard, recorded or otherwise. My older brother left me a copy of Time Out  before he left for college. I think I played that thing until the vinyl grooves wore out. I can hear the fantastic syncopation of Blue Rondo Al La Turk, DADA DADA DADA, DA DA DA DADA DADA DADA in my head. Brubeck made jazz a lifelong passion for me and no doubt for millions like me.

He'll be missed.

Eli

Denver In Denver

Bill,

That's how the Butcher household (Patriots fans all) used to refer to all those away games at Mile High. It seems we were always playing there, and  mostly losing. At lot of Patriot heartache happened there. The Elway teams were always well coached. The defense made you pay in blood for every yard gained. And, or so it seems in my memory, there would always be some terrible (from this side of the rivalry) moment that determined the outcome. For exhibit A one only need refer to "Bailey, Champ."

I don't think the earlier contest this season tells us much. Manning the Elder clearly had not found his comfort zone. The Patriots on the other hand, are famous for peaking in December, and their porous pass defense to appears to have strengthened a bit. The Ravens in Baltimore are the major remaining test on your side, while we have the 49ers and the Houston, both at home.

Should be fun

Eli

One more time on ACA solving the access problem?

Eli,

Tell me again about ACA solving the access problem:

Bill

From Brad DeLong, 

Brad DeLong: A Question for ACA Implementation Gurus...

http://delong.typepad.com/sdj/2012/11/a-question-for-aca-implementation-gurus.html

A QUESTION FOR ACA IMPLEMENTATION GURUS...

I understand that CMS has absolutely no desire to encourage more cream-skimming, and every desire and internal incentive to make sure that those who treat more difficult patient populations are not financially penalized by doing so.

I understand that as a country we are spending twice as much as western European countries while lagging 2 years behind them in life expectancy and 20% behind them in treatment coverage. I understand that the hope is that it will be cheaper and quicker to treat your 32 million new Medicaid and exchange-based insured now that they are showing up regularly with insurance rather than showing up in severe crisis only.

But Massachusetts has been walking down this exchange-and-public-program-expansion road for six years now, since Mitt Romney signed RomneyCare. Massachusetts has been vacuuming up doctors and nurses from Costa Rica and elsewhere and still has been finding that the cost of treating your state population is higher when 97% are insured than it was when 88% were insured. And there aren't enough loose doctors and nurses in the rest of the world for the ACA to vacuum up enough of them to meet the needs of not 1 state but 50 states.

The investments in medical infrastructure and workforce--less than $30 billion for 32 million newly insured, less than $1000 for newly insured--seem an order of magnitude low.

What is your guess as to what will happen if the ACA works for access, works for quality, works for coverage--but the extra health-care workforce needed isn't there, and the lines start to get longer?

Tell Me that Part About ACA Solving Access Issues Again.

Eli,

The Huffington Post reports Wal-Mart will respond to the incentives created by the ACA by reducing employee hours to less than 30 hours per week. Under ACA, it will not have to offer health insurance. Instead, workers will be subsidized by you and me.

Walmart, the nation’s largest private employer, plans to begin denying health insurance to newly hired employees who work fewer than 30 hours a week, according to a copy of the company’s policy obtained by The Huffington Post.

I suppose you could say this is a positive feature of ACA in that it picks up insurance coverage. But it's a pretzel logic that can come to the conclusion lowering worker's hours so they receive fewer benefits from employers is a good thing since they'll now be rescued by the government.

Employees of Wal-Mart, Welcome to your liberal paradise!

Bill

Manning v. Brady

Eli,

My Broncos and your Patriots both clinched this weekend. I hope they meet in the playoffs as it is always a good game when any Manning and Brady (aka Johnny Bravo) play against each other. I've been unable to see much of my Broncos this year, but the wins seem to be more impressive every week. Seven in a row. Of course, in Denver, they always talk Super Bowl even before the season starts. After yesterday's win,  it might not be that crazy.

Bill

Is the ACA the Answer?

Bill

As I have argued previously, the ACA is at best an imperfect solution. It solves the problem of access but not (yet) of cost. It's not the solution I would have chosen (although you would have liked that even less). But it can't (and won't) be any worse than what we've done so far, so far, which is to feed the medical industrial monster.

And I have the same hold-my-head-in-hands reaction as you to the argument that letting "consumers" decide all this in the hurly burly of a market driven healthcare system is the answer. Such a system will certainly be cheaper, since, as in 3rd world countries, it will only provide care to those who can pay.  And there is no reason to believe, and certainly no previous experience to suggest, that it will deliver better health, or even adequate health for those who can't.

Eli

The Game is Increasingly Rigged

Eli,

The "game" as you call it, or the allocation of resources is not rigged yet, but unfortunately increasingly it is so. President Obama famously says he wants an economy where "everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules." I think it's the height of hypocrisy particularly the part about everyone playing by the same rules.

A $90 billion Department of Energy direct subsidy and loan guarantee program for solar, wind and battery producers is explicitly favoring one over another, explicitly different rules for different players.

The bail-out of GM and Chrysler is explicitly favoring those two companies over Ford and the domestic production of Honda, Toyota, Nissan etc. It explicitly suspends the rules for a favored player.

Cash for clunkers, which is certainly one of the most useless programs of the past few years, and there is a lot of competition for most useless, suspends the rules for car buyers during a short window of time. Subsidizing the purchase of electric vehicles shows favoritism to some players.

Visa, Mastercard, American Express and the banks spend billions to offer consumers the convenience of using credit and debit cards for everyday purchases. Retailers embrace the technology to lower their costs, increase throughput and attract consumers. One day, Senator Dick Durbin (D-IL) decides the fees retailers pay to banks is too high and unilaterally lowers those fees resulting in fewer free checking accounts for low-balance depositors, which had been subsidized by the card fees. Fair shot. Fair share. Same rules.

Dodd-Frank institutionalizes too big to fail, increases the costs to operate smaller banks, resulting in a shift in market share to the larger banks.

Tax filers with AGI greater than $200,000 generate 27% of total personal adjusted gross income and pay 51.75% of total income taxes. Filers with AGI between $50,000 and $200,000 generate 50% of total adjusted gross income and pay 41.55% of total income tax. Which means these 48.9 million filers pay 91% of the total income tax. 3% of the filers with AGI greater than $200,000 pay 52% of the total income tax collected and including filers with AGI over $50,000 34% of the filers pay over 90% of the total income tax. Fair share. Same rules. Fair shot.

Teenagers with little work experience or skills to offer employers are priced out of the labor market dooming them to chronically high unemployment. Fair shot.

Mortgage relief programs are a hodge-podge of rules and incentives leading to higher unemployment and a calcified market. Fair shot. Same rules.

All of these programs plus ethanol subsidies, the Ex-Im bank and the multitude of other programs and subsidies that favor the connected, who use that connection to become rich result in the rigged game.

What has Obama done to change the rigged game? Rigged it more. It's the Democratic Party go-to response: if something isn't working-Do More of It. You are right, Americans may be more willing to accept the reality of higher taxes or fewer services if they believe the game isn't rigged. But unless Obama has a Saul on the road to Damascus moment, it's not happening with this administration.

Bill