Wednesday Links

Posted on by John C. Goodman

Judge: the federal government cannot conspire with social media to limit free speech.

Expanded Child tax credit: Neither labor force participation nor total hours worked changed significantly during the months when benefits were increased and work requirements were removed.

Study: Medicare enrollment improves financial health.

About 39 percent of US workers are engaged in nontraditional work (freelancing, contracting, gig, and self-employment).

7 thoughts on “Wednesday Links”

  1. “estimate the effect of universal health insurance at age 65—when most Americans become eligible for Medicare”

    1. It would seem self-evident that people whose medical care becomes subsidized would on average bear less debt. But there’s more to the findings here. The paper ends with this sentence “These findings highlight a potential limitation of policies such as the ACA, that delegate states considerable latitude in policy implementation, and a relative advantage of programs such as Medicare that are federally-administered – specifically that the former may exacerbate geographical disparities while the latter tend to reduce them”.

    Those findings are worth considering. Note they form a basis for arguing that there should be more federalized, centralized ACA administration, diminishing the roles delegated to the states. A classic management issue. The findings also seem eerily self-evident. Could not the same conclusion apply in general to grocery stores, auto repair shops, restaurants, local suppliers, school curricula, etc? If reductions in the variance of outcomes is desirable for medical care, is the same true for other businesses serving the public?

    2. Some years ago Arnold Kling suggested comparing the experience for seniors in countries with universal coverage, with the experience for seniors in Medicare. What are the medical conditions and outcomes? Does American universal insurance for seniors cost less, more, or about the same vs the population of seniors in countries with universal medical insurance? What factors are in play and how do they differ? still think that was a great idea but, to my knowledge, no one has taken him up on it.

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  2. The ACA intended to expand Medicaid on a national basis, but this effort was stymied by lawsuits in 2012.
    The states which did not expand Medicaid to childless adults included Alabama, Florida, Georgia, Mississippi, No Carolina, So Carolina, Tennessee and Texas.

    It was obvious I think to all analysts that the working poor in those states would have higher medical debt until they turned age 65 and got onto Medicare.

    The opponents of Medicaid expansion — led by Michael Cannon, the Galen Institute, and other fiscal conservatives — thought that defeating the Dems was more important than relieving poor patients and safety-net hospitals of medical debt.

    Some might consider them to be principled defenders of liberty and fiscal sanity; others might consider them to be selfish prigs who assume they will never be poor themselves.

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  3. American self-anointed”progressives” always seem to use concern for the poor as a fig leaf to disguise some other objective. In the case of medical care, their objective was to implement a universal, nationalized medical welfare program. That had been the objective of the Democratic Party since Truman. Their best opportunity in decades arrived in 2009 when the Democrats took control of both houses of Congress and the White House. Their objective was a national plan. The window dressing was concern for the poor. If otherwise, they would have focused on fixing Medicaid, not on creating yet another vast federal insurance scheme.

    Why? Because in 2004 and 2005, Americans below 2Xs the Federal Poverty line accounted for 65% of all uninsured, non-elderly Americans. If these Americans could have been enrolled in Medicaid – the existing government program designed for the poor – the uninsured rate in America would have dropped to about 6%.

    HHS released a report in late 2022 stating the “uninsured rate reached an all-time low” earlier in the year. That all-time low rate was 8%.

    But 8% is bigger than 6%. All that time. All those dollars spent. And there are still significant numbers of uninsured, mostly poor.

    Worse Medicaid is still not meeting the needs of the poorest Americans. Despite spending about $725 billion this fiscal year. Also, ACA is obligated to increase its subsidies every year to keep up with medical cost increases. The Obama administration told us those cost increases would not occur because ACA would bend down the cost curve. Fact is, the cost curve at present bends upwards at roughly the same rate as when ACA was fully implemented in 2014.

    This little history demonstrates that the government did not solve the uninsured problem it promised to solve. Instead it created a vast and expensive new entitlement program that not only saddles the country with more spending – but it’s not performing as promised. If helping the poor and the uninsured had been the actual objective from the beginning, I would expect the government’s results would look a lot different today.

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  4. I do not disagree with your skepticism about the motives and policies of the Democrats.

    However, I do want to debate one specific point that you made. You imply that it would have been a good thing if Americans who earn less than 2Xs the poverty line could have been enrolled in Medicaid.

    Well, the ACA legislation provided federal money for the states to do exactly that. The federal money would cover all the costs in the early years of enrolling all poor people up to 138% of the poverty line.

    The Southern states refused the deal. Some made the point that when the federal money reduced after a few years, the states would have to tax their residents a little more.

    A cynic would say that these states did not want to tax themselves in any way to fund a program whose major beneficiaries were black people. (and whose legislative champion in 2010 was a black president.)

    Excluding the poor from Medicaid was not the fault of Washington.

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  5. “Well, the ACA legislation provided federal money for the states to do exactly that.”

    So states resisted? So they chose to fight a political battle rather than to fight for their own weakest constituents? Yeah. Exactly. Reverse the parties in this situation, my bet would be on the same cynical outcome.

    But that’s all aside from my point that the Congress and Administration were not mainly seeking to help the poor and uninsured in the first place. They were mainly seeking to establish the vast new federal bureaucracy called ACA. States resistance to a Medicaid solution actually furthered the Feds’ main objective.

    The Feds’ used the poor and uninsured to sell ACA to a credulous public. Never let a crisis go to waste. And, famously, they relied on the ignorance of the American people to sell it, slyly wording the bill so the legislation would not be scored as a tax and wake up the public. Bullies always claim their victims “ask for it” so they beat them up for their own good.

    So we still have 8% uninsured, ACA, and Medicaid that costs over $700 billion yearly.

    btw, 138% of the poverty line falls well short of 200% of the poverty line.

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  6. Most of the G-7 nations have a tradition of social solidarity, wherein they make sure that poor and minority citizens have at least minimal health coverage.

    Some American states have the same tradition….Minnesota, Massachusetts, New York. Other states (especially the former slave states) do not.

    Your contention is that the federal government uses this gap in order to cynically advance its own power.

    The argument about cynical federal power-grabs was used in the 1960’s against the voting rights movement. I was so disgusted by that Southern resistance that I “tuned out” the anti-federal argument altogether. It makes me opinionated on this issue, I admit.

    One small point — the ACA is not a vast new bureaucracy. In my state the ACA website has about 50 employees. The state department of insurance has maybe 100 more workers dealing with health insurance. The total cost of ACA subsidies is about $121 billion a year. That is a lot of dough, but it is not a vast bureaucracy. About 90% of Americans never come in contact with the ACA.

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    1. “Most of the G-7 nations have a tradition of social solidarity, wherein they make sure that poor and minority citizens have at least minimal health coverage.”

      Most of the G-7 nations have not borne the full cost of providing for their defense over the past 75 years thanks to the military protection of the United States, and American taxpayers. That’s why G-7 nations could afford a tradition of social solidarity. Much of which was adopted or expanded post-WWII. UK for example launched NHS in 1948.

      It was a shock to all of them when U S demanded they start paying a much greater share of their defense costs. But it was way past time for us to make that demand.

      And now I am going outside to play. Take the last word if you must.

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